Death Certificate Data Collection Form

AFS - Death Certificate Data Form
PLEASE READ THIS SECTION AND INSTRUCTIONS CAREFULLY.

This form is designed to help us accurately enter data for the Death Certificate.

This form is better filled on a Computer or Tablet.

The details that you provide will be copied and pasted into the BDM Site.

Please be very careful of names and spelling.

Any changes after submission to the Department of Births Deaths and Marriages, will incur a $129 Fee.

The form is quite long and it is better to complete in one sitting.

You are advised to have the following data sources with you, to help you fill the form:
- The Birth Certificate of the Late Deceased.
- The Marriage Certificate(s) of the Late Deceased.
- As complete Details of the Late Deceaseds Siblings (Brothers and Sisters)
- As complete Details of the Late Deceaseds Children
- As complete Details of the Late Deceaseds Parents or Parental Figures
- Any other sources of official data you may have (Passports etc...)
These documents DO NOT need to be submitted. They are only needed for you to get correct data.

If there is no available data to fill out in a field, please type NONE.

ALL FIELDS ARE REQUIRED. IF THERE IS NO DATA, ENTER THE NUMBER "0" OR THE WORD "UNKNOWN".
Yes, I have read and understand the instructions provided on this page.*

Yes, I confirm I understand.

Deceased's Marriage Details
Marital Status at Time of Death *
Please record current and all previous marriage or defacto relationships:
Location of Marriage *
Where exactly did they get married?
Country of Marriage*
Suburb/Town/City of Marriage*
Age at Marriage Commencement*
What Age did they get married at?
Spouse Details
Family Name *
First Given Name *
Other Given Name(s) *
Sex *
Number of Additional Marriages*
If there are additional marriages please let Agnee Funerals know and we will send you an email back with instructions on how to record these.
Additional Spouse Details*

Children of the Deceased

Fields are provided for the details of 1 Child. If there are more children, Click on the Button "Next Child Details" to add
Number of Children*
Child 1 Details
Family Name
First Given Name
Other Given Name(s)
Life Status
Date of Birth

DayMonthYear
Date
Age
Age Value
Sex
Child 2 to 10 Details
Next Child Details:*

Informant's Details

These are YOUR details, That is, the details of the person filling out this form
Family Name*
First Given Name *
Other Given Name(s)*
Relationship To Subject *
The Subject is the Deceased
Residential Address Country*
Your Full Residential Address*
Your email address
example@example.com
Your Phone Number
Mobile Preffered
Should be Empty:

AFS - Death Certificate Data Form