Document ID: chunk:federal_register_of_legislation:F2018L00351:schedule:1:p1
Version: federal_register_of_legislation:F2018L00351
Segment Type: schedule
Provision Reference: sch 1 (pt 1/3)
Character Range: 8503–16285

Schedule 1—Forms
Note: See sections 6 and 15.

Form 1—Application for registration of a death abroad

              BIRTHS, DEATHS AND MARRIAGES

              APPLICATION TO REGISTER A DEATH ABROAD
Form 1 ‑ ADA  Registration of Deaths Abroad Act 1984 (Cth)
              Registration of Deaths Abroad Regulations 2018 (Cth)

Applicant's phone number        Registration Number
                                (Office use only)

PARTICULARS OF DECEASED
Surname                                                                                                                                                                                                                                                                                             Given Name(s)

Date of Death                                                                                                                                                                                                                                                                                       Time of Death                                                Place of Death
 / /                                                                                                                                                                                                                                                                                                am/pm
If the death occurred on board a flying craft or ship: (a) name or flight number of flying craft or name of ship (b) name of carrier or registered owner (c) location of craft or ship at time of death (d) port of origin of the flight or voyage (e) port of destination of the flight or voyage

(a)     (b)    (c)

(d)     (e)

Date of Birth                                                                                                                                                                                                                                                                                       Gender                                                       Place of Birth
 / /
Nationality                                                                                                                                                                                                                                                                                         Last known occupation

Relationship status (e.g. married, de facto, single, divorced, widowed)                                                                                                                                                                                                                             Surname of spouse or de facto partner (if applicable)

Former name of spouse or de facto partner (if applicable)                                                                                                                                                                                                                                           Given Name(s) of spouse or de facto partner (if applicable)

Children of the deceased (first name, surname)                                                                                                                                                                                                                                                      Date of Birth                                                Gender                Deceased
                                                                                                                                                                                                                                                                                                     / /                                                                               oNo oYes
                                                                                                                                                                                                                                                                                                     / /                                                                               oNo oYes
                                                                                                                                                                                                                                                                                                     / /                                                                               oNo oYes
                                                                                                                                                                                                                                                                                                     / /                                                                               oNo oYes
Parent Surname (e.g. mother)                                                                                                                                                                                                                                                                        Parent Former Surname (if any)                               Parent Given Name(s)

Parent Surname (e.g. father)                                                                                                                                                                                                                                                                        Parent Former Surname (if any)                               Parent Given Name(s)

Details of Residence
Usual place of residence

Where person resided in Australia at any time, the address/es at which the person resided                                                                                                                                                                                                                                                                                                                                                     Period of residence

Grounds (if any) on which the applicant has reason to believe that the person: (a) was an Australian citizen (b) ordinarily resided in Australia or in an external Territory of Australia (c) was in receipt of a pension, allowance or benefit under the Social Security Act 1991 (d) was in receipt of a pension, allowance or benefit under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004.
(a)
(b)
(c)
(d)

Particulars of benefits payable by commonwealth
If the deceased was in receipt of a salary, pension, allowance or other benefit from the Commonwealth or an authority of the Commonwealth, details of that benefit.

Medical particulars
Cause of death

Full name of medical practitioner, coroner or other authority furnishing medical particulars

BuRIAL/CREMATION PARTICULARS
Date of Burial/Cremation      Place of Burial/Cremation
 / /

DeTAILS OF APPLICANT
Rank or Title                                                                                                       Surname                                              Given Name(s)

Relationship to deceased                                                                                            If not related, period applicant knew the deceased

If not related, grounds on which the applicant knows the identity of the deceased

Has an application for registration of death been made to any authority and, if not the Registrar, which authority

If