Birth Certificate Request Form

 

 

To complete your request, the following info is required:

1. Government ID

For security and privacy, a photo or scan of a government issued ID is required.  We will also call you to verify the identity.

2. Information of person for whom the birth certificate is requested

Person's Name

 First name:

 Last Name: 

 Postal Address: 

 Telephone: 

 Email Address: 

3. Name of parents of the person:

 Father Information

 First name:

 Last Name: 

 Mother's Maiden Name

 First name:

 Last Name: 

4. Birth Location of the person:

 City: 

 Country of Birth: 

5. Witnesses (name of 2 people that served as witnesses at the time of birth or two (2) names of people who know you well)

  Witness name #1: <first name>, <surname>

  Witness name #2: <first name>, <surname>

6. Were the parents married at the time of birth? Yes/No

 

Pricing:

The fee is as follows:

a) $65 U.S. dollars plus shipping, for the STANDARD service of 4-8 weeks

b) $100 U.S. dollars plus shipping, for the EXPRESS service of 2-3 weeks

c) $125 U.S. dollars plus shipping, for the ULTRA service of 1-2 weeks

Payment of the fee is done online at https://www.haitinet.com (search for "birth certificate”).