Information Application Form

Information Application Form

For people seeking to access their birth, care, early life & medical information.
If you are looking to request information from adoption records, please complete this form. This form is for:

1. An adopted person

2. A person who was nursed or boarded out

3. A person who may have spent time in a Mother and Baby Home or other institution

4. A person whose birth may have been illegally registered

5. A son or daughter of an adopted person where the relevant person is known to be deceased

6. A relative of an adopted person where the relevant person died in a Mother and Baby Home or other institution.

This form has five sections

Section 1	General Information
Section 2	Your current personal details
Section 3	Application details
Section 4	What informtion are you requesting?
Section 5	Identification and signature

Section 1: General Information
What is this application form for?

The Birth Information & Tracing Act 2022 allows people who have been affected by the issue of adoption to request that the Adoption Authority conduct a search of their records and, if located, provide copies of documents from the records(s) pertaining to the applicant. By submitting this application form, the Adoption Authority is obliged to either provide any documents relating to the applicant or inform the applicant that a search of Authority’s records returned no relevant files.

What adoption records do the Adoption Authority hold?

The Adoption Authority holds files for every adoption that was legally recognised in the Republic of Ireland since the legalisation of the process in 1952. In addition, we hold some files where the adoption process was started but never completed. The Adoption Authority holds the following adoption files:
- Adoption Authority, formerly An Bord Uchtála, which includes private and family adoptions before 2009
- Cúnamh, formerly known as the Child Protection & Rescue Society of Ireland (CPRSI)
- PACT, formerly known as the Protestant Adoption Society, which includes records from the following locations and bodies
  - Denny House
  - Fairfield Children’s House
  - Bethany House
  - The Magdalen Home
  - The Nursery Rescue Society
  - Here2Help
- St. Brigid’s Adoption Society
- St. Thérèse Adoption Society
- Westbank Orphanage, also known as The Protestant Orphanage Charity
- ISPCC Irish Society for the Prevention of Cruelty to Children (ISPCC)
- Records of some institutions listed in Schedule 1 of the Birth Information and Tracing Act 2022.
Upon receipt of a completed application form the Adoption Authority will conduct searches of the above records and endeavour to locate all information relevant to the applicant.

How will I receive my information?

This application form allows the applicant to choose how they receive their information. If requested, information can be sent via email as long as the applicant gives us permission. The information will be encrypted and attached to an email and a password will be given to you to access it. All information sent through the post will be by registered mail and will require your signature before being released. Where you have requested medical information for a genetic relative, this will be sent directly to your nominated medical practitioner (e.g. your General Practitioner).

Who can apply for information?

The Adoption Authority can accept applications for information from the following:
- An adopted person (a legally recognised adoption).
- A person who was nursed or boarded out (a care arrangement that may have been organised by the State).
- A person who may have spent time in a Mother and Baby Home or other institution. This may have been before a formal adoption took place or a care arrangement was organised.
- A person whose birth may have been illegally registered (where a birth was illegally registered and no formal adoption took place).
- Son or daughter of an adopted person where the relevant person is known to be deceased.*
- Relative of an adopted person where the relevant person is known to have died while he or she was a resident in a Mother and Baby Home or other institution.*
* Please note, if you are applying for information relating to a deceased person, you will have to provide proof of death with this application form. The Adoption Authority will only accept the following documents as proof of death:
1. A death certificate or a copy of a death certificate
2. A published obituary
In some cases, proof of your relationship to the deceased will also be required. For example, if your father was adopted and is now deceased, we will require your birth certificate to prove your relationship to the adoptee.

Section 2: Your current personal details

Please provide your email address, postal address or phone number. we will use these details to send you the information you have requested.
Your first name(s):*
Your last name:*
If you have previously used other names (like a maiden name, please add them here):
Your date of birth (if unsure or not known please provide the date you are most confident of):

DayMonthYear
Your phone number (landline or mobile):

Area CodePhone Number
Your Postal address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your email address
example@example.com
Please choose the format you would like to receive your information in:*

Electronic copy (email)Paper copy (post)

Section 3 : Application details
Please choose the description that best suits your status as an applicant.

For example, if you know you were adopted in the Republic of Ireland, you would choose Person adopted from Ireland. You should tick all those that apply to you, for example if you were fostered/boarded out and then adopted later:
Your Status as an applicant*

Person adopted from IrelandPerson adopted from outside IrelandA person who may have spent time in a Mother & Baby home or other institutionSon of an adopted person who is known to be deceasedDaughter of an adopted person who is known to be deceasedRelative of a person who is known to have died in a Mother & Baby Home or other institutionA person who was fostered/boarded outA person whose birth may have been illegally registeredOther
If Other (please provide your status)
You can use the space below to add any information which might help us locate relevant records
If you are applying for information relating to your own adoption, including foster cases and possible illegal registrations, please skip to Section 4

If you are requesting information relating to an adopted person (including foster cases and individuals placed in an institution) who is known to be deceased, please complete the following steps:

Please provide the details for the person whose information you are requesting
Name of the person
If you are aware of the name of the adoption agency that handled your adoption (e.g. St Patrick’s Guild, Cúnamh etc.), please select it from the drop down menu:
Agency Name
Date of birth (if unsure or not known, please provide the date you are most confident of):

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Please remember to attach one of the following documents as proof of death:
- A death certificate or a copy of a death certificate
- A published obituary
Where proof of death is necessary it is essential that one of the above douments is provided or else the application will not be processed

Section 4: What information are you requesting?
You can choose more than one of these options. Please tick the boxes to show what information you are requesting*

Original Birth CertificateBirth Information and Early Life InformationCare Information (for those who were in a care arrangement)Medical InformationMedical Information of a Genetic RelativeIncorrect Birth Registration InformationProvided items (If applicable)
Note: If you are requesting medical information on a genetic relative please provide the name and address of you medical practioner below
Name and Postal Address of your Medical Practitioner

Section 5: Identification and signature
I, the Applicant, consent to my scanned written signature or my electronic signature or my typed signature being used by the Adoption Authority of Ireland to authorise my agreement to the information provided on this form.
Consent options*

YesNo
By signing this form, I acknowledge that to the best of my knowledge, all information given by me is true and accurate. I also confirm that the personal identification provided by me is true and accurate.
Acknowledgement options*

YesNo
What form of identification are you sending?*

PassportDriving licence (including provisional licence)Garda Age CardPublic Services Card
Upload your identification*

Cancelof
By signing this form:
- I acknowledge that to the best of my knowledge, all information given by me is true and accurate.
- I consent to my scanned written signature or my electronic signature or my typed signature being used to authorise the processing of my data for the purposes of my application.
- I confirm that the personal identification provided by me is true and accurate.
Your Signature or mark:*

Clear
Date of Application*

MonthDayYear
Note: This is an extremely serious and sensitive matter for those involved. The adoption authority will report any person who misuses the form to An Garda Síochána
Should be Empty:

Information Application Form

Section 1: General Information

Section 2: Your current personal details

Section 3 : Application details

Section 4: What information are you requesting?

Section 5: Identification and signature