Deceased's Details

This online form can be completed to help start the funeral arrangement process and can be completed with the assistance of one of our funeral consultants during a personalised consultation, or you may choose to complete this in your own time prior to meeting with us. We suggest scrolling down to view the questions before you start so you can first gather any information you may need.

Please Contact Us for immediate, personal assistance.

Alternative form for printing:
Download the Births Deaths and Marriages - Death Registration Form

 Privacy Policy

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I understand that the information I enter will not be saved until I click SUBMIT at the bottom of the form/page.

• I Understand

Remember not to click any links that will guide you away from the form until it is complete.

Deceased's full name

Applicant's full name

Applicant's email address required

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PART A - DETAILS OF THE DECEASED

Family name Surname

Family name at birth Surname at birth (maiden name)

First given name required

Other given name/s (middle name/s) Please provide name/s in correct order if there are multiple middle names

Other name/s (also-known-as or nick name/s) e.g. Legal name John but everyone knows him as "Jack"

Sex

• Female
• Male
• Other

required

Date of Death --- January February March April May June July August September October November December --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --- 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027

Approximate time of death if known (please also indicate AM or PM)

Date of birth --- January February March April May June July August September October November December --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --- 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899

Age at date of death Enter age at last birthday

Did death occur in a NSW hospital or nursing home?

• Yes
• No

required

Place of death Name of hospital or nursing home (if applicable), OR full address of place of death

Usual residence of the deceased (in full) required

Place of birth (country, suburb, state) Please check spelling is correct

If born overseas, what date did the deceased first arrive in Australia? If date unknown, state the year of arrival if known

Usual occupation during working life (if applicable) Please give full title of one main occupation (NOT "Retired" or "Pensioner")

Main tasks usually performed in that occupation

Was the deceased retired at date of death?

• Yes
• No

Was the deceased a pensioner at date of death?

• Yes
• No

If "yes", state the type of pension

• Not Applicable
• Aged
• Invalid (Disability)
• War Veteran
• Other

Pension notes or reference number

OPTIONAL: You can upload a copy of the Deceased's pension card or pension details

Luke Apthorpe & Family will notify Centrelink or Dept. Veterans Affairs that the death has occured, and we recommend you contact them directly for any other Pension enquiries

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Was the deceased of Aboriginal or Torres Strait Islander origin?

• Aboriginal
• Torres Strait Islander
• Both Aboriginal or Torres Strait Islander origin
• Neither (Not Applicable)

required

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• I/We Understand and Agree to this Privacy Policy

required

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