BIRTHS DEATHS AND MARRIAGES APPLICATION TO REGISTER A

BIRTHS DEATHS AND MARRIAGES APPLICATION TO REGISTER A

DESCARGAR PDF


BIRTHS, DEATHS AND MARRIAGES
----------------------------
APPLICATION TO REGISTER A DEATH ABROAD
Registration of Deaths Abroad Act 1984 (C’wlth)
Registration of Deaths Abroad Regulations 1985 (C’wlth)
Form 1 - ADA
IMPORTANT INFORMATION
This form can be used to register the death of a prescribed person who
has disappeared from an Australian aircraft while it was in flight, an
Australian ship while it was at sea, a flying craft (other than an
Australian aircraft) while it was in flight on an Australian flight,
or a ship (other than an Australian ship) while it was at sea on an
Australian voyage. A prescribed person means a person who is an
Australian citizen or, ordinarily resides in Australia or, is in
receipt of a pension, allowance or benefit under the Social Security
Act 1991 (C’wlth) or is in receipt of a pension, allowance or benefit
under the Veterans’ Entitlements Act 1986 (C’wlth) or is receiving
weekly amounts of compensation under the Military Rehabilitation and
Compensation Act 2004. Registration of a death abroad is not
compulsory.
To enable registration of a death abroad certain documents need to be
lodged with this form to support the application including: a Death
certificate, missing person reports to police, outcomes of coronial
inquests, a Medical Practitioner’s certificate or reports or logs from
aircraft or ship crew and a Transport of Body certificate,
identification of the deceased such as passport. Details of disposal
in Australia. If any documentation is in a foreign language, an
official English translation is required. All original documentation
supplied with the application form will be returned to the applicant
only if requested. Applicants are also required to provide 3 forms of
identification upon application of which at least one must display the
applicant’s current residential address and signature.
There is no fee to lodge an application to register a death abroad.
However, a fee does apply if a certificate is required. For further
information and forms to apply for a certificate please visit our
website https://www.accesscanberra.act.gov.au
PRIVACY INFORMATION
The Births, Deaths and Marriages Registration Act 1997 authorises the
Registrar-General to collect the information required by this form.
The Registrar-General prevents any unreasonable intrusion into a
person’s privacy in accordance with the Information Privacy Act 2014.
The Registrar-General may provide identifiable information to law
enforcement organisations and authorised organisations that have legal
authority to request information under prescribed circumstances.
Documents provided as proof of identity may have their authenticity
verified through the National Document Verification System (DVS).
Documents issued by this office may also be verified by external
agencies using DVS.
INSTRUCTIONS FOR COMPLETION
*
If completing this form by hand please use black pen only.
*
This office will not accept lodgement of this form if it is not
completed in full.
*
Any alteration to information provided on this form must be struck
through with black pen and substitute information must be clear
and all parties must sign in the margin. Do not use white out.
*
If you are lodging this application in person you must supply
original documentation.
LODGEMENT AND CONTACT INFORMATION
Email:
[email protected]
Post:
Access Canberra
Births, Deaths and Marriages
GPO Box 158
Canberra, ACT 2601
In Person:
Please visit www.act.gov.au/accessCBR
Or call 132281 to find an
Access Canberra Service Centre
If you require further information or require advice, a language
assistance service is available by phoning the
Translating and Interpreting Service (TIS) on 13 14 50

BIRTHS, DEATHS AND MARRIAGES
----------------------------
APPLICATION TO REGISTER A DEATH ABROAD
Registration of Deaths Abroad Act 1984 (C’wlth)
Registration of Deaths Abroad Regulations 1985 (C’wlth)
Form 1 - ADA
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
(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 of voyage
(a) (b) (c)
(d) (e)
Date of Birth
Sex
Place of Birth
/ /
Male Female Unspecified Indeterminate Intersex
Nationality
Last known occupation
Marital status
Surname of spouse (if applicable)
Domestic Partnership Civil Partnership Married Divorced Widowed
Former name of spouse (if applicable)
Given Name(s) of spouse (If applicable)
Children of the deceased (Given names in full)
Date of Birth
Sex
Deceased
/ /
Female Male Unspecified
Indeterminate Intersex
No Yes
/ /
Female Male Unspecified
Indeterminate Intersex
No Yes
/ /
Female Male Unspecified
Indeterminate Intersex
No Yes
/ /
Female Male Unspecified
Indeterminate Intersex
No Yes
Mother/Birth Parent Surname
Mother/Birth Parent Former Surname (If any)
Mother/Birth Parent Given Name(s)
Father/Other Parent Surname
Father/Other Parent Former Surname
Father/Other 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 other
authority, and if so, which authority
If an application for registration of deaths was made to another
authority, was the application refused and reason
DECLARATION BY APPLICANT
I,
(full name)
being a
(occupation)
of
(address)
Email Address:
I certify that I have read this form thoroughly and that the
particulars are correct. I understand that a person who intentionally
makes a false statement in a declaration is guilty of an offence under
the Crimes Act and I believe that the statements in the declaration
are true in every particular.
Signature:
Date:
Page 4 of 4