Fillable Apply For Death Certificate (New South Wales)

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Apply For Death Certificate (New South Wales)

On average this form takes 18 minutes to complete

The Apply For Death Certificate (New South Wales) form is 2 pages long and contains:

  • 0 signatures
  • 3 check-boxes
  • 70 other fields

Country of origin: AUSTRALIA
File type: PDF

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Certicate entitlement
This application form can only be used if the death occurred in
NSW. If you are the next of kin named on the death certicate,
i.e. spouse (married/defacto/same sex defacto), parent or child
of the deceased, the death certicate can be issued to you. If
you are a relative not listed on the certicate, the certicate can
be issued to you if the deceased had no living spouse, children
or parents.
If you DO meet the above criteria, you must provide:
• Three forms of your own ID (see below).
If you DON’T meet the above criteria, you must provide:
• A Letter of Authority (available at: www.nsw.gov.au/bdm)
giving permission from the next-of-kin. Please include their
address, phone number and signature.
• Three forms of ID from the next-of-kin (see below).
• Three forms of your own ID (see below).
Identication (ID)
Please provide at least three forms of ID, one of each from
categories 1, 2 and 3. If you are unable to provide ID from
categories 1 and 2, you must still provide at least three forms
of ID. At least two of these must be from category 3.
All documents except foreign passports must be current.
Category 1 Category 3
If born in Australia:
• An Australian birth certicate
Record of immigration
status:
• Citizenship certicate
• New Zealand citizenship
certicate
• New Zealand birth certicate
• Medicare card
• Credit or debit card
• Centrelink or Department of
Veterans Aairs card
• Security guard/Crowd control
licence
• Tertiary education institution
ID card
Category 2 Category 4
• Australian driver’s licence
• Australian passport
• Firearms licence
• Foreign passport
• Proof of age card
• Recent utility account with
current residential address
(issued within last three
months)
Disclosure of information
When you complete this application form, understand that you
have consented to the release of information provided, to those
agencies who may be able to validate the information in support
of your application. More information: www.nsw.gov.au/bdm
Your right to privacy
To protect your privacy, the Registry requires proof of your
identity. In line with the NSW Births, Deaths and Marriages
Registration Act 1995 and the Privacy and Personal Information
Protection Act 1998, the Registry collects information to
determine your eligibility to obtain a certicate and to prevent
fraud. Information may be used for statistical purposes and by
law enforcement agencies, and other uses by law. Please read
the Your Right to Privacy policy on our website.
Online
You can complete this online at www.nsw.gov.au/bdm
Lodging by post
GPO Box 30
SYDNEY NSW 2001
Lodging in person
Service NSW service centres
service.nsw.gov.au
Phone: 13 77 88
• Monday to Friday (7am-7pm)
Hearing/Speech impaired, phone:
• TTY 133 677
• NRS 1300 555 727
Translating and Interpreting, phone:
• TIS National 131 450
Death Certificate
Application
YOU CAN
COMPLETE THIS
APPLICATION
ONLINE AT:
nsw.gov.au/bdm
Form 10 06/2020
Form 10 06/2020
Death Certicate Application
Please specify the quantity you wish to receive e.g.
1
Standard death certicate
International Registered Post
Reason certicate is required
Your relationship to the deceased
(e.g. probate, executor) (e.g. son, mother, executor)
DETAILS OF DEATH CERTIFICATE REQUIRED
Date of death*
/ /
Age at death
Registration number
/
*If date unknown, period to be searched: From
/ /
To
/ /
Names of registered person
Family name Family name at birth
First given name Other given name(s)
Place of death
Spouse details
Family name Family name at birth
First given name Other given name(s)
Parent 1 details
Family name Family name at birth
First given name Other given name(s)
Parent 2 details
Family name Family name at birth
First given name Other given name(s)
(Current)
(Current)
(Suburb/Town/City)
of deceased
(Current)
(If known)
(Note, each extra 10 year search or part thereof incurs a cost)
dd mm yyyy
dd mm yyyy dd mm yyyy
APPLICANT’S DETAILS (details of person completing this form). Please provide copies of 3 forms of current identication with your application.
Family name
First given name
Other given name(s)
Company name Company reference number
Address
Suburb/Town/City
State/Territory
Postcode
Country
Delivery Address
Suburb/Town/City
State/Territory
Postcode
Country
Contact number
Email address
(If applicable)
(If applicable)
(If dierent from above)
Signature
of applicant
I certify that I understand the provisions overpage
on Identication, Privacy & Disclosure and that
the information I have provided is true and correct.
✗
PRINT clearly in BLACK pen and complete all details.
Do you require Priority processing of your application?
Yes Fee applies, see website for details.
YOU CAN COMPLETE THIS APPLICATION ONLINE AT: www.nsw.gov.au/bdm
ABN 81 913 830 179
GPO Box 30 Sydney NSW 2001 Tel: 13 77 88
PAYMENT DETAILS (complete this section for mail applications only). Please refer to www.nsw.gov.au/bdm for fees.
Total Amount $
.
Please debit my: AMEX
Mastercard
Visa OR Enclosed is a cheque*/money order
Card number
* Make cheques payable to NSW Department
of Customer Service (non Priority only)
Name
Expiry date
mm / yy
of cardholder
Signature
of cardholder
✗
A surcharge applies to credit card payments at the
rate of 1.4% for AMEX and 0.4% for Mastercard or Visa.
1
01/01/
31/12/
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Apply For Death Certificate (New South Wales)

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Completed 9 October 2021

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