Commemorative Birth Memento Request Form

Please note: This Commemorative Certificate and Coin is only available to babies who were born in 2021 and whose parents/guardian live in the Mid & East Antrim Borough Council area.

This form should only be completed by the baby's parents.

DO NOT complete this application if you are not resident in the former Ballymena, Larne or Carrickfergus council areas. Those outside the borough should contact their own local Councils to see if they have a similar project.

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* 1. Applicant Details

Name *

Address *

Address 2

City/Town *

Postal Code *

Email Address *

Phone Number *

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* 2. Do you (the baby's parent/guardian) live in Mid & East Antrim borough?

Yes

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* 3. Was the baby born in 2021?

Yes

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* 4. Birth Certificate Reference Number

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* 5. Name of Child

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* 6. When was the baby born?

Baby's date of birth:

Date

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* 7. Consent

I consent to Mid and East Antrim Borough Council processing and storing my personal/child’s information in relation to the commemorative birth memento.

Privacy Notice

Mid and East Antrim Borough Council is collecting and processing your personal/child’s information under the ‘consent’ lawful basis as defined by the Data Protection Act 2018. We will keep the information secure, accurate and for no longer than is necessary in accordance with data protection laws. If you wish to find out more about how we control and process personal data and protect your privacy please visit the following

https://www.midandeastantrim.gov.uk/privacy-notice