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)




 Male Female

Date of Birth

Place of Birth

Arrival Date in Australia

Pension type

Pension Number

Marital Status
 Married Widow/er Divorced Never Married

Are you Aboriginal or Torres Strait Island original?
 Yes No


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.


Father's name

Father's occupation

Mother's name

Mother's maiden name

Mother's occupation

Funeral Details

 Burial Cremation

Cemetery or Crematorium location

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


 Minister Civil Celebrant

Hym or Music Requests for the Service

Newspaper Notices - which newspapers?

Floral Tributes
 Yes No

 Cut flowers only No Flowers

Donations in lieu of flowers
 Yes No

Name of Organisation

Member of the RSL
 Yes No

Member of Masonic
 Yes No

Phone Number