Request a Congratulatory Message

To request a message from the Premier in acknowledgement of a significant birthday or anniversary, fill in the form below and Melina will pass it on to the Department of Premier and Cabinet on your behalf.

Type of verification provided:

Birth Certificate Marriage Certificate Statutory Declaration Passport Other

If other, please specify

Type of congratulatory message:

Birthday - 90 years Birthday - 100 years Wedding Anniversary - 50 years Wedding Anniversary - 60 years Wedding Anniversary - 65 years Wedding Anniversary - 70 years

Nominee(s) title:

Nominee(s) full name(s):

Nominee(s) address:

Nominee(s) town:

Nominee(s) State

Postcode

Address to be sent if different from above:

Requester name:

Requestor phone:

Requester email:

Date of Anniversary / Birthday:

Date message should arrive:

Upload Verification Documents:

Give us feedback

(03) 5174 7066

First Name

Last Name

Postcode

Message

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Melina Bath MP