Personal & Family Detail Form

Personal & Family Details

The following information will assist family or the executor in meeting legal requirements necessary for the registering of the death. The information is sent to the State registry of Births, Death & Marriages when a death occurs.

Family Name (required)

Given Name (required)

Address

Suburb

Postcode

Sex
MaleFemale

Date of Birth

Place of Birth

Arrival Date in Australia

Pension type

Pension Number

Marital Status
MarriedWidow/erDivorcedNever Married

Are you Aboriginal or Torres Strait Island original?
YesNo

Marriage

Place of marriage

Age when married

Name of spouse

Children - full names and date of birth
(including any legally adopted, stillborn and deceased children)

If more than one marriage, please give details.

Parents

Father's name

Father's occupation

Mother's name

Mother's maiden name

Mother's occupation

Funeral Details

BurialCremation

Cemetery or Crematorium location

Location of service (e.g. Chapel, Church, Home, Garden etc.)

Religion

MinisterCivil Celebrant

Hym or Music Requests for the Service

Newspaper Notices - which newspapers?

Floral Tributes
YesNo

Cut flowers onlyNo Flowers

Donations in lieu of flowers
YesNo

Name of Organisation

Member of the RSL
YesNo

Member of Masonic
YesNo

Phone Number

Email