Document ID: chunk:federal_register_of_legislation:F2018L00351:schedule:1:p3
Version: federal_register_of_legislation:F2018L00351
Segment Type: schedule
Provision Reference: sch 1 (pt 3/3)
Character Range: 20669–24079

other benefit from the Commonwealth or an authority of the Commonwealth, details of that benefit.

PARTICULARS OF WITNESSES
Surname of witness who last saw person alive  Given Name(s) of witness who last saw person alive

Address of witness who last saw person alive

Surname of other witness who last saw person alive  Given Name(s) of other witness who last saw person alive

Address of other witness last saw person alive

Surname of other witness who last saw person alive  Given Name(s) of other witness who last saw person alive

Address of other witness last saw person alive

Particulars of Disappearance
Such particulars of the time at which, the date on which, and the circumstances in which, the person disappeared as are known to the applicant

Particulars of the grounds the applicant has for believing that the person has died

(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 disappearance (d) port of origin of the flight or voyage (e) port of destination of the flight or voyage

(a)     (b)     (c)

(d)     (e)

Documents in support of application
List the documents furnished as evidence that the person is dead

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 person who has disappeared

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

If an application for registration of death was made to any authority, was the application refused and reason

DECLARATION BY APPLICANT
I,                                                                                                                                                                                                                                                          being a
 (full name)                                                                                                                                                                                                                                                   (occupation)
of
 (address)
Email address:
certify that I have read this form thoroughly and that the particulars provided are correct. I understand that giving false or misleading information is a serious offence. I believe that the statements in the declaration are true in every particular.
Signature:                                                                                                                                                                                                                                                  Date:

Form 3—Certificate for copy or extract of entry in the Register

Registration of Deaths Abroad Regulations 2018

COMMONWEALTH OF AUSTRALIA

I hereby certify that the above particulars are contained in an entry in the Register kept in the Australian Capital Territory.

Given under my hand and seal this (insert date).

(signed)
Registrar of Deaths Abroad