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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
Year 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
Year 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
Year 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(s)
*
Age
*
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. Father/Parent's surname (family name)
*
24. Father/Parent's given name(s)
*
25. Father/Parent's surname at birth
*
26. Occupation of the Father\Parent during working life
*
Part 6 - Siblings of the Deceased
27. Was the deceased under 18 years of age?
*
Yes
No
28. 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
29. Are you the nearest surviving relative of the deceased?
*
Yes
No
30. What is your relationship to the deceased?
*
31. Are you an executor of the deceased's estate?
*
Yes
No
32. Have all the near relatives been notified of the cremation?
*
Yes
No
33. Have any of the near relatives objected to the proposed cremation?
*
Yes
No
34. Did the deceased leave any written directions as to the mode of disposal of his/her remains?
*
35. 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?
*
36. Usual Medical Practitioner's name
*
37. Usual Medical Practitioner's address
*
38. The name of the Medical practitioner(s) who attended during the deceased's last illness
*
39. The address of the Medical practitioner(s) who attended during the deceased's last illness
*
40. Was any battery powered device attached to or present in the deceased (eg pacemaker)?
*
