Sydney 21 14

Funeral

DEAtH REGISTERATION DETAILS

islamic Society of Victoria Burial Service

90 Cramer Street, Preston, Victoria, 3072
Mob : 0417889956
Ph : 0394702424
Fax : 0394702424
Email : info@isv.org.au

DEATH REGISTRATION INFORMATION FORM

Steb 1 -Deceased's Details Funeral Number
5- Sex of deceased
7- Place of death
8- Was the deceased born in Australia ?
9- For how long did the deceased live in Australia?

OR

Year Arrived
10- Usual Residential Address
11- Usual occupation during working life
12- Was the deceased retired ?
13- Was the deceased a pensioner?
14- Was the deceased of Aboriginal or Torres Strait island origin?
Step 2 - Deceased's relationships
15- Did the deceased have apartner at the time death ?
if previously married, please list all marriages of the deceased ( starting with the most recent )
16- List all pervious relationships of the deceased starting with the most recent
Step 3 - Children of the Deceased
17- Did the deceased have any children ?
Provide birth details of each child in order of birth ( from oldest to youngest ). include any legally adopted children. if a child is deceased, enter 'D' in the age file. if not born alive, enter 'SB' in the age field
1- Child's given name(s) [ Delete ]
Age
Step 4 - Parents of the Deceased
Setp 5 -Siblings of the Deceased
25. Was the deceased under 18 years of age ?
27. Does the deceased have any siblings?
Provide birth details of each sibling ( whether full or half blood ) in order of birth from oldest to youngest. include legally adopted siblings, step brother(s) and step sister(s). if asibling is deceased, enter 'D' in the age filed. if not born alive, enter 'SB' in the age filed.
if yes, specify siblings details Add siblings
Siblings given name(s) and surname
Date of birth
Age
Place of birth State (or country if born outside Australia)
Step 6- Informant's Detalis
28. Who supplied you the deceased information (i.e.the informant)
29. Informant's residential address
30. Daytime telephone number
31. What is the relationship of the informant to the deceased person ?
32. How did the informant provide the details of the deceased
Step 7 - Disposal of the Deceased's Remains
33. How were the remains of the deceased disposed?
OR
OR
34. When were the deceased's remains disposed of or sent overseas?
35. Were the deceased remains disposed of within 30 days of death?
Specify the name and address of person with custody of the remains and reason for not disposing of them within 30 days
Step 8 - Medical Practitioner or Coroner's Details
36. Who certified the death of the deceased person
36.3 Business address
36.4 Business name
36.5 Daytime telephone number
36.6 Email address
36.7 What is the Medical Practitioners Board of Victoria ( MPBV ) registration number of the doctor who notified you of the death ?
OR
Step 9 - Funeral Director's Certification
37. who is certifying the disposal of the deceased's remains ?
38. Business Address
39. Daytime telephone number
40. Email Address
41. Signature
Date

Reminder - it is the Registery's strong preference to only send 1 certificate to a single address ( i.e.1 certificate to the informant named above ).