(Name of Parent) (Name of Representative) to claim a copy of Authenticated PSA Birth Certificate of my child . To order a birth certificate you will need: Name of the child at birth; Date of birth; City of birth; The mother's maiden last name.Find below, an example of authorization letter for PSA to adapt to your personnal needs. You can also download this document in word format. Select the relationship that identifies you as the authorized party to request the Birth Certificate. You may be required to provide supporting documents. 1. Get an Application Form - Birth Certificate (White Form) from the Information Marshal's booth and fill-out the required information in PRINTED LETTERS. Once the form is filled out, send it to the Appeals Coordinator at your Regional Headquarters. If you need help filling out the form, ask your parole agent.