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Personal Information Form

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© France Family Funerals 2006

 

The following information is required by the Registry of Births, Deaths and Marriage (N.S.W) at the time of death occurs. France Family Funerals will complete all the necessary legal requirements regarding the registration od death, as well as ordering certificates and contacting Centrelink and/or Veteran's Affairs on behalf of your family. By taking just a few moments to complete this form you will greatly benefit your family in the future.

Once completed, please press the submit button. Once submitted, a copy of this form will be lodged with France Family Funerals and print friendly version will be available for you copy to keep and keep in a place known to your family.

PDF Click here to download a copy of the Personal Information Form.
Personal Details
Name of Applicant
Date:
Title: Dr         Mr         Mrs      Ms         Miss         Other
Surname:
Given Names:
Address:
Suburb: State:    Postcode:
Date of Birth: / / Country of Birth:
If not born in Australia, state the year settled in Australia Year:
Are you of Aboriginal or Torres Strait Islander Origin?                     No              Aboriginal        Torres Strait Islander  
Occupation (If retired state former occupation):                               
Retired:     Yes      No        Type of Pension (If app.) Number:
Doctor's Name: Doctor's Phone: ( )
Doctor's Address:


Marital Status:		 Married          Widow/er         Divorced      Separated       Never Married     

De Facto (Please also tick one of the above categories)
Religion:
Name of Minister/Pastor/Religious Leader:
Marriage Details
1st Marriage    
Place of Marriage:
Suburb: State:         Postcode:
Date of Marriage: / /

Full name of Spouse:
(At date of Marriage,
Maiden if app.)
 
2nd Marriage    
Place of Marriage:
Suburb: State:         Postcode:
Date of Marriage: / /

Full name of Spouse:
(At date of Marriage,
Maiden if app.)
 

If more then 2 marriages please complete with appropriate information

 

Children
Please provide full names, dates of birth and sex.
Child 1  
Name:
Date of Birth: / /
Sex: Male      Female   
Deceased: Yes      No  
Child 2  
Name:
Date of Birth: / /
Sex: Male      Female   
Deceased: Yes      No  
Child 3  
Name:
Date of Birth: / /
Sex: Male      Female   
Deceased: Yes      No  
Child 4  
Name:
Date of Birth: / /
Sex: Male      Female   
Deceased: Yes      No  

If more than 4 Children please complete with appropriate information

 

Parents

  

Father's Full Name:
Mother's Given Names: Maiden Name:

Sender's Details

  

Name:

Address:

Phone:

Email:
   
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