Cremation Application Form

Deceased details

First Name *

Middle Name(s)

Surname *

Also known as (surname)

Optional — use when the deceased has another legal surname, for example from a previous marriage.

Gender *

Aboriginal?

Date of Birth Unknown / To be confirmed

Date of Death Unknown / To be confirmed

Usual occupation

Age

Calculated where possible; can be corrected manually.

Place of birth

Suburb / Town

State

Country

Place of death and usual residence

Place of Death

Hospital Nursing Home Home Other

Usual residence

Other information

Coroner investigation into death?

Did the deceased leave written directions about how their remains were to be dealt with?

Do you know of anyone who objects to the deceased’s remains being cremated?

Does the deceased have a pacemaker or any electrical devices fitted?

Family details

Marriages

What was the deceased's marital status?

Children

Did the deceased have any children?

Parents

Parent one

Relationship / type

Given Names

Surname

Maiden surname (if applicable)

Usual occupation

Parent two

Relationship / type

Given Names

Surname

Usual occupation

Applicant / informant

Given Names *

Surname *

Mobile *

Email *

Relationship to deceased *

On Form 6, the applicant is applying as

Applicant address *

Certification

I certify that the information provided is, to the best of my knowledge and belief, true and correct for the purpose of being inserted in the Register of Deaths.

Signature *

The signing date and time will be recorded with the submission.