Death Registration form – Sydney Memorial Cremations

Your Contact Details

Name

First

Last

Email

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Deceased Information

Name

First

Middle

Last

Please state complete legal name

Gender

Male
Female
Unstated

Last Known Residential Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Death

(DD/MM/YYYY)

Date of Birth

(DD/MM/YYYY)

Age

in years

Place of Death

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Place of Birth

City and State and country if not Australia

Migration Date or Year

Occupation During Working Life

Please enter even if deceased is retired. Please enter their longest employment or Trade. Please also define the main activity of this occupation

Pensioner

Retired

Pension Type

Aboriginal or Torres Strait Island origin

Deceased Marriage Details

Please state all marriages including divorced or deceased spouses.

Marital Status

Spouse full name

First

Middle

Last

Please enter spouse details even if they are divorced or widowed.

Maiden Name

First

Middle

Last

Please enter spouse details even if they are divorced or widowed.

Place of Marriage

Please enter spouse details even if they are divorced or widowed.

Age at time of Marriage:

More than one marriage

Deceased's Children Details

Please state all children alive or deceased including stillborn children by order of birth.

Did the Deceased have children?

How Many children?

Child 1 Full name

First

Middle

Last

Childs 1 Life Status

Alive
Deceased
Stillborn
Unknown

Child 1 Date of Birth

Child 1 Gender

Male
Female
Unstated

Child 2

Child 2 Full name

First

Middle

Last

Childs 2 Life Status

Alive
Deceased
Stillborn
Unknown

Child 2 Date of Birth

Child 2 Gender

Male
Female
Unstated

Child 3

Child 3 Full name

First

Middle

Last

Childs 3 Life Status

Alive
Deceased
Stillborn
Unknown

Child 3 Date of Birth

Child 3 Gender

Male
Female
Unstated

Child 4

Child 4 Full name

First

Middle

Last

Childs 4 Life Status

Alive
Deceased
Stillborn
Unknown

Child 4 Date of Birth

Child 4 Gender

Male
Female
Unstated

Child 5

Child 5 Full name

First

Middle

Last

Childs 5 Life Status

Alive
Deceased
Stillborn
Unknown

Child 5 Date of Birth

Child 5 Gender

Male
Female
Unstated

Did the deceased have more than 5 children?

Deceased Parents Details

Deceased's Parents details. If any fields are unknown please write "unknown" in them. We still need these details even if they are deceased or retired. please enter unknown for any unknown items.

Mothers Full Name

First

Middle

Last

Mothers Surname from Birth

Mothers Occupation

EG: Home Duties, Teacher etc. Please enter A trade or type of employment even if they are deceased or retired. - please also define the main activity of this occupation

Fathers Full Name

First

Middle

Last

Fathers Surname from Birth

Fathers Occupation

EG: Home Duties, Teacher etc. Please enter A trade or type of employment even if they are deceased or retired. please also define the main activity of this occupation

Informant Details

This is the person who provided the information above and will also be receiving the death certificate.

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

Did the deceased have a pace maker?

No
Yes
Unknown

Name and Address of last seen General Practitioner

We need full name and address of the doctor the deceased used regularly towards the end of life. If unknown, please write "Unknown"

Service Information

If you are having a direct service Please go ahead and submit the form. If you are having a service, you can enter some of the information below.

Are you having a Service or Direct Cremation or Burial?

Preferred Date / Time for the service

Date

Time

Are you having the service At our Chapel in Roselands or Elsewhere?

Roselands
Elsewhere
Unsure yet

if Else Where, please specify where you would like to hold the service?

Do you wish to Book in a Celebrant or Clergy

If you would like to book in a celebrant or Clergy for your service, please choose one of the options above.

Photo Upload

Click or drag files to this area to upload. You can upload up to 10 files.

Please feel free to upload photos here. You can upload up to 10 photos. Which can be used on your memorial photo frames or Memorial cards.

Have you made Music Selections?

If so, please enter Title and Artist here and we can commence sourcing them for you.

Coffin Selection

If you have seen the Full Package inclusion Pdf in your quote, it will demonstrate the available coffin selections in your package.

Floral Selection

Please enter the colour of flowers you would like for the floral casket cover.