Personal Information Form

Information Required By Registrar In Event Of Death

SURNAME

MAIDEN NAME (IF APPLICABLE)

GIVEN NAMES

DATE OF BIRTH

OCCUPATION

IF PENSIONER, STATE TYPE

TOWN OF BIRTH

STATE OF BIRTH

COUNTRY OF BIRTH

IF NOT BORN IN AUSTRALIA, STATE YEARS OF RESIDENCY

MARITAL STATUS

HOME ADDRESS LINE 1

HOME ADDRESS LINE 2

CITY

STATE

POST CODE

PARENT DETAILS - PARENT 1

New Field:

PARENT DETAILS - PARENT 2

New Field:

MARRIAGE PARTICULARS

New Field:

2ND MARRIAGE

New Field:

3RD MARRIAGE

CHILDREN

If Deceased enter (D)

Child 2

Child 2 DOB

Child 3

CHILD 3 DOB

Child 4

CHILD 4 DOB

Child 5

CHILD 5 DOB

Child 6

CHILD 6 DOB

Child 7

CHILD 7 DOB

Child 8

CHILD 8 DOB

NEXT OF KIN - CONTACT DETAILS

New Field: