Form to Enable Registration of Death

The information below is required by Births Deaths & Marriages New Zealand for the registration of a death. If you do not have some of the required information please place N/R in the appropriate space. This means 'not recorded' and this will be shown on the original death certificate.

Please make sure you fill in all required (*) fields.

Deceased Surname *
 
Deceased Maiden Name
 
Full Names
 
Age
 
Sex
 
Date of Birth
 
Place of Birth
 
Country
 
Date of Death
 
Time
 
Place of Death
 
Deceased's Occupation
 
Years in NZ
 
Ethnic Group
 
Maori Blood
 
Justice of the Peace
 
Marriage/Civil Celebrant
 
Honours (QSM, OBE, etc)
 
Mother's Full Name
 
Nee
 
Mother' Occupation
 
Father's Full Name
Father's Occupation
 
Deceased Relationship Status At Death
 
 

Most Recent Relationship

Deceased Partner’s Full Name
 
Partner’s Maiden Name
 
Age of Deceased at Marriage
 
Town/City
 
Ages of Living: Daughters
Ages of Living: Sons
Age of Living Spouse
 
 

Other Relationship

Deceased Partner’s Full Name
 
Partner's Maiden Name
 
Age of Deceased at Marriage
 
Town/City
 
Ages of Living: Daughters
Ages of Living: Sons
Age of Living Spouse
 
Relationship Ended By
Divorce/Separation/Death
 
 

This Form Completed By

Name *
 
Email Address *
 
Phone Number *
 
Comments
 
 
Confirmation Code
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Confirmation Code
 
Enter Code *
 
 
 
 
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