Personal Information Form

Below is the information required to register a Death.

SURNAME

MAIDEN NAME (IF APPLICABLE)

GIVEN NAMES

DATE OF BIRTH

OCCUPATION

IF PENSIONER, STATE TYPE

TOWN OF BIRTH

STATE OF BIRTH

COUNTRY OF BIRTH

IF NOT BORN IN AUSTRALIA, STATE YEARS OF RESIDENCY

MARITAL STATUS

HOME ADDRESS LINE 1

HOME ADDRESS LINE 2

CITY

STATE

POST CODE

PARENT DETAILS - PARENT 1

New Field:

PARENT DETAILS - PARENT 2

New Field:

MARRIAGE PARTICULARS

New Field:

2ND MARRIAGE

New Field:

CHILDREN

Child 1 DOB (If Deceased, 'D')

Child 2

Child 2 DOB

Child 3

CHILD 3 DOB

Child 4

CHILD 4 DOB

NEXT OF KIN - CONTACT DETAILS

YOUR NAME

New Field: