NSW/ACT Hospital authority

Office use only

Who are you making arrangements with?*

Auto-fill this form

YesNo

Please do not print this document from this screen as you will miss important steps.

Rather, please complete the form on your device and be sure to click the "Send to Salvos Funerals" button at the end.

(You should then receive an email with a PDF attachment. That PDF would only need to be printed if you do not sign on your device).

Place of passing of your loved one*

ACTNSW

In what city/region is your loved one?*

Are they in the care of a Hospital or the Newcastle Coroner?*

HospitalCoroner

NSW hospital*

ACT hospital *

Facility*

This is information required by NSW Health. Your answers will be transcribed to a PDF (see here). The formal title is "Authority to collect deceased".

This questions below are to be completed by the Executor or Next of Kin.

This is information required by hospitals in the ACT. Your answers will be transcribed to a PDF (see here). The formal title is "Authority to collect deceased".

This questions below are to be completed by the Executor or Next of Kin.

Review only

Do you need guidance as to whether you can sign this form?*

YesNo

This should be completed by the executor of the deceased person’s will. If this person is not available or there is no will then the following hierarchy can be used as a guide to identify the next of kin:

Next of kin of a deceased adult means, in the following order of seniority:
1. a person who was a spouse or de-facto (including same sex partner) of the deceased immediately before the person’s death
2. where the deceased person has no spouse or the spouse is not available, a son or daughter of the deceased person, who has attained the age of 18 years
3. where no person referred to in 1 or 2 is available, a parent of the deceased person
4. where no person referred to in 1, 2 or 3 is available, a brother or sister of the deceased person, who has attained the age of 18 years

Next of kin of a deceased child means, in the following order of seniority:
1. a parent of the child
2. where a parent to the child is not available, a brother or a sister of the child, who has attained the age of 18 years
3. where no person referred to in point 1 or 2 is available, a person who is guardian of the child immediately before the child’s death.

If the person who assumes the role as the Senior Next of Kin does not wish to provide authority, they may nominate another person as their “delegate”. Reason for this delegation must be documented in this form.

Surname:*

Use CAPITALS only for SURNAMES

Given names:*

Your given and surname - duplicated on form

Relationship to your loved one*

Are you an executor of the estate?*

YesNo

Are you the nearest surviving relative (also known as Next of Kin)?*

YesNo

Who has asked you to act on their behalf?*

Next of KinExecutor

Have you been asked by the Executor/Next of Kin to act on their behalf?*

YesNo

Next of Kin given names*

Use Title Case

Executor given names*

Use Title Case

Next of Kin surname*

USE CAPITALS

Executor surname*

USE CAPITALS

Next of Kin - answer

Executor - answer

Next of Kin/Executor - answer

Reason this application is being made by you*

Written authority for making this applicationRequested by Next of KinAm the Power of Attorney of Next of KinOther (if so, write reasons in next field)

Reason - answer

If you have been asked by the Executor/Next of Kin to act on their behalf, please provide details:*

N/A

Phone number:*

{funeralPlanner} - leave this field blank if you do not want the family to receive an email with the Authority to Collect form.

Email:*

Street address 1:*

Street address 2:

Suburb/Town:*

State/territory:*

State/territory*

Postcode:*

Your address - answer

-Your loved one's surname is the same as yours

YesNo

Surname*

Use CAPITALS only for SURNAMES

Given names.*

Loved one's given names and surname - duplicated on form

Sex.*

MaleFemale

Loved one's sex - duplicate

MaleFemale

Date of birth*

Approx. weight*

Weight - answer

Weight - duplicated

Loved one's date of birth - duplicate

Facility - duplicate

Hospital email - answer

Hospital name - answer

St George Hospital email

St George Hospital name

Westmead Hospital email

Westmead Hospital name

Gosford Hospital email

Gosford Hospital name

Your loved one's address is the same as yours

YesNo

Street address 1.*

Loved one's Street address 1 - duplicated on form

Street address 2.

Suburb.*

State/territory.*

State/territory*

Postcode.

Street 2, Suburb, NSW. Postcode - duplicated on the form

Street 2, Suburb, State. Postcode - triplicated on form

Loved one's given names - triplicated on form

Loved one's surname - triplicated on form

Disposition.*

CremationBurialRepatriationAbove-ground Burial

Paperwork - answer

Paperwork - duplicate

*Burial paperwork please

*Cremation paperwork please

Type of arrangement*

Direct cremation only (ie. no family or friends in attendance)Basic funeral and cremation (at either Smeaton Grange, Narellan or Tuggerah)Personalised funeral (eg: in a crematorium chapel)

Disposition and type of arrangement - answer

Disposition and type of arrangement duplicate- answer

Funeral planner full name

Funeral planner given name

Funeral planner email

Phone number

Central Coast number

Sydney number

Transfer company

Personal Services Australia

Independent Mortuary Services

I confirm that I have full and proper authority to permit the facility to release the body of the above named deceased person to Salvos Funerals.

Sign on your screen below using the whole box (or sign another way after clicking "Submit" button at the end of this form)

Please sign on the screen with a finger or stylus

Not signed - answer

Date

Today's date

Planner's typed signature*

YesNo

Signature of Salvos Funerals planner

Please sign on the screen with a finger or stylus

Planner - typed signature

Funeral director signature - Date

Once you submit this form, we will make arrangements to bring your loved one into our care when appropriate.

Checked Preview PDF before submitting*

Yes

Auto-fill other forms

YesNo

Authority to collect loved one from a hospital

Before we begin

Your details

Your contact details

Loved one's details

Loved one's address

Type of arrangement

Confirmation