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
 
Address
 
Date of Birth
 
Date of Death *
 
Place of Death *
 
Sex
 
 

Required Information

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

Most Recent Relationship

Deceased Partner’s Full Name
 
Partner's Maiden Name
 
Town/City
 
Age of Living Spouse
 
Ages of Daughters
(If Deceased - Age at Death [Years])
Ages of Sons
(If Deceased - Age at Death [Years])
 

Other Relationship

Deceased Partner’s Full Name
 
Deceased Partner's Maiden Name
 
Town/City
 
Relationship Ended By
Divorce/Separation/Death
 
Ages of Daughters
(If Deceased - Age at Death [Years])
Ages of Sons
(If Deceased - Age at Death [Years])
 

This Form Completed By

Name *
 
Email Address *
 
Phone Number *
 
Comments *