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 fostered or boarded out
3.	A person who may have spent time in a County Home or in a Mother and Baby Home
4.	A person whose birth may have been illegally registered
5.	A son or daughter of a deseased relevant person
6.	A relative of a relevant person who died in a County Home or in a Mother and Baby Home

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 for?

The Birth Information & Tracing Act 2022 allows people who have been affected by adoption to request that the Adoption Authority of Ireland 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 process the application and either provide a copy of any birth and early life records relating to the applicant or inform the applicant that a search of the Authority’s records returned no relevant files.

How will the applicant receive the information?

This application form allows the applicant to choose how they receive their information. If requested, information can be sent via email. The information release will be password protected and attached to an email. The password will be sent to you under separate cover. All information sent through the post will be by registered post. Where an applicant has requested medical information for a genetic relative, this will be sent directly to the 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 fostered or boarded out (a care arrangement that may have been organised by the State).
- a person who may have spent time in a County Home or in a Mother and Baby Home. 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 a revelant person who is deceased.*
- A relative of a relevant person is known to have died while resident in a County Home or Mother and Baby Home.*
* Please note, if an applicant is applying for information relating to a deceased person, they will have to provide proof of death with the application form. The Adoption Authority will only accept the following documents as proof of death:
1. a copy of a death certificate or
2. a published obituary
In some cases, a document, (e.g. a copy of your birth certificate) to prove your relationship to the deceased may also be required.

Can I nominate a friend or family member to help me?

Yes, an applicant can nominate a friend or a family member to assist them in completing the form. However, you will still need to apply in your name and the requested information will be released to you. Here is what you need to do:
1. Sign or make your mark at the end of the application form.
2. In a separate letter (of consent), give the name of the friend or family member who is going to help you.Tell us that you are happy to allow the nominated person to act or be contacted on your behalf.
3. Date and sign or make your mark at the end of the letter of consent.
4. Send us the following:
- the completed application form
- the dated and signed letter of consent
- your identification document (copy)
- identification for the friend or family member who is helping you (copy)

Section 2: Your current personal details

Please provide your personal email address, postal address or phone number. we will use these details to communicate with you.
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 County Home or in a Mother & Baby HomeSon 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 County Home or in a Mother & Baby HomeA 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
Agency Name
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:
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
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 copy of a death certificate or
- A published obituary
Where proof of death is necessary it is essential that one of the above documents 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 available)
Note: If you are requesting medical information of a genetic relative please provide the name and address of your medical practitioner 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 and other relevant documents*

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