BDM Registry

Your name

Family name

First given name

Other given names

Your address

Address line 1

Address line 2

Suburb / Town / City

State / Territory

Post code

Country

Your contact details

Telephone

Your relationship to the deceased

I am the deceased's

Details of the deceased

Family name

Family name (at birth)

First given name

Other given names

Gender

Usual residential address of the deceased

Address line 1

Address line 2

Suburb / Town / City

State / Territory

Post code

Country

Date of birth

Place of birth

Country

Suburb / Town / City

State / Territory

If born overseas, what date did the deceased first arrive in Australia?

(If the exact date is not known, please state the year of arrival)

Year of arrival

Usual occupation during working life (if applicable)

(Please give full details. For example, Music Teacher, Machine Operator)

Was the deceased retired at date of death?

Yes No

Was the deceased a pensioner at date of death?

Yes No

If Yes, please state what type of pension (e.g. Invalid, Aged, Veterans)

Was the deceased of Aboriginal or Torres Strait Islander origin?

Aboriginal origin Torres Strait Islander origin Both Aboriginal and Torres Strait Islander origin Neither

Place of death

Did the death occur in a NSW hospital or nursing home?

Yes No

If Yes, insert name of hospital or nursing home

Date of death

Address where they died

Address line 1

Address line 2

Suburb / Town / City

State / Territory

Post code

Country

Parent one (mother)

Relationship to the deceased

Mother Parent

Family name

Family name (at birth)

First given name

Other given names

Gender

Usual occupation during working life (if applicable)

Parent two (father / parent / mother)

Relationship to the deceased

Father Mother Parent

Family name

Family name (at birth)

First given name

Other given names

Gender

Usual occupation during working life (if applicable)

Marriages or relationships of the deceased

Marital status of the deceased at time of death

(Only include a de facto if it was the most recent relationship)

(Enter marriages or relationships in order of most recent to oldest)

Relationship one

Relationship type

Place of marriage

Country

Suburb / Town / City

State / Territory

Age of the deceased at start of relationship

Spouse details

Family name of spouse/partner when married (at date of marriage/relationship)

Family name of spouse/partner at birth

First given name of spouse/partner

Other given names of spouse/partner

Gender of spouse/partner

Children of the deceased

Did the deceased have any children?

Yes No

If yes, please specify how many children (include legally adopted children)

Enter each child in order of birth

First child

Family name

Family name (at birth)

First given name

Other given names

Age of this child

Gender

Is this child alive?

Informant details

(Note: Informant details are from step 1)

Your name

Your address

Your contact details

Submission date

Date of submitting the form:

I declare that the information I have provided is true and correct. I understand that it is an offence under Part 5A of the Crimes Act 1900 to provide false or misleading information or documents and that it is an offence under the Births, Deaths and Marriages Registration Act 1995 to make a false or misleading representation in an application, notice or document.

Signature

Home

Death Registration – Registry of Births, Deaths & Marriages