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"Death Registration"
INFORMATION REQUIRED TO REGISTER THE DEATH
Part 1 - Your Contact Details
1. Name
*
2. Email
*
3. Phone
*
4. Relationship to deceased
*
5. Address
*
Part 2 - Deceased's Details
6. Full, correct name of the deceased person
*
7. Date, Time and address of place of death
*
8. Date and place of birth
*
9. If born overseas, how long did he/she live in Australia
10. Usual residential address
*
11. Usual occupation
*
12. Was he/she retired?
*
13. Was he/she receiving a pension?
*
14. Was he/she of Aboriginal or Torres Strait origin?
*
Aboriginal
Torres Strait
Both
Neither
Part 3 - Deceased's Relationships
15. Did he/she have a partner at the time of death?
Yes
No
Married
In a Domestic Relationship
Widowed
Divorced
Single
Unknown
16. If Married, please list all marriages of the deceased (Starting with the most recent)
Marriage 1
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Place of Marriage Suburb/Town
State
Country
Date of marriage
Marriage 2
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Place of Marriage Suburb/Town
State
Country
Date of marriage
Marriage 3
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Place of Marriage Suburb/Town
State
Country
Date of marriage
17. If Domestic Relationship, please list all relationships of the deceased
Domestic Relationship 1
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Is the relationship registered?
Yes
No
Place of Registration - State\Territory
Country of registration
Year of Registration
Domestic Relationship 2
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Is the relationship registered?
Yes
No
Place of Registration - State\Territory
Country of registration
Year of Registration
Domestic Relationship 3
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Is the relationship registered?
Yes
No
Place of Registration - State\Territory
Country of registration
Year of Registration
Part 4 - Deceased's Children
18. Did the deceased have any children?
Yes
No
If YES, please specify each child's details.
Child given name(Full Name)
Date Of Birth
Part 5 - Parents of the Deceased
19. Mother/Parent's surname (family name)
20. Mother/Parent's given name(s)
21. Mother/Parent's surname at birth
22. Occupation of the Mother\Parent during working life
23. Mother/Parent's Date of birth
24. Father/Parent's surname (family name)
25. Father/Parent's given name(s)
26. Father/Parent's surname at birth
27. Occupation of the Father\Parent during working life
28. Father/Parent's Date of birth
Part 6 - Siblings of the Deceased
29. Was the deceased under 18 years of age?
Yes
No
30. Does the deceased have any siblings?
Yes
No
If YES, specify siblings details.
Siblings given name(s) and surname, Date of Birth, Age, Place of Birth
Part 7 - Applying for the Cremation
31. Are you the nearest surviving relative of the deceased?
Yes
No
32. What is your relationship to the deceased?
33. Are you an executor of the deceased's estate?
Yes
No
34. Have all the near relatives been notified of the cremation?
Yes
No
35. Have any of the near relatives objected to the proposed cremation?
Yes
No
36. Did the deceased leave any written directions as to the mode of disposal of his/her remains?
37. Do you have any reason to suspect that the death was not natural or suppose an examination of the remains of the deceased may be required?
38. Usual Medical Practitioner's name
39. Usual Medical Practitioner's address
40. The name of the Medical practitioner(s) who attended during the deceased's last illness
41. The address of the Medical practitioner(s) who attended during the deceased's last illness
42. Was any battery powered device attached to or present in the deceased (eg pacemaker)?
