At Need Form - Fixed Price Cremations

1Your details

2Their details

3Relationships

4Family information

5Applying for the cremation

6Final Confirmation

Your Details

The person making the application for cremation

Applicant's name

First name Surname

Phone

How would you like us to contact you?

Phone

Either/ No preference

Your relationship to the person who has died

Your residential address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Details of the person who has passed away

Please provide the following details about the person who has died. Some of this information will be provided to Births, Deaths and Marriages to register their death. Please enter names, dates and other details as accurately as possible.

Full legal name(Required)

First name Last name

Details of their death

Date of death

Day

Month

Year

Time of death

Hours

Minutes

AM/PM

Place of death(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Personal details

Date of birth(Required)

Day

Month

Year

Place of birth(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Was the person who has died born overseas?

Yes

How long did they live in Australia?

Usual residential address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Usual occupation

Please provide their usual occupation during their working life.

Were they retired?(Required)

Yes

Were they receiving a pension?(Required)

Yes

Were they of Aboriginal or Torres Strait Islander origin?(Required)

Aboriginal

Torres Strait Islander

Both Aboriginal and Torres Strait Islander

Neither

Relationships

Births, Deaths and Marriages requires relationship information when a death is registered. It’s important that these details are as accurate as possible, as they may appear on the death certificate and can be important when managing the person's estate.
Please provide their relationship history below.

Did the person who has died have a partner at the time of their death?

Yes

Marriage history

Were they ever married?

Yes

Marriage 1

Please provide details of their marriage or marriages, starting with the most recent.

Partner's given name(s)

Partner's family name

Partner's sex

Male

Female

Place of marriage

Street Address City State / Province / Region ZIP / Postal Code Country

Date of marriage

+ Add another marriage

Yes

Marriage 2

Partner's family name

Partner's given name(s)

Place of marriage

Street Address City State / Province / Region ZIP / Postal Code Country

Date of marriage

Month

Day

Year

Domestic relationship history

Was the person who died in a domestic relationship?

Yes

Please provide details of their domestic relationship or relationships

Partner's given name(s)

Partner's family name

Partner's sex

Male

Female

Was the relationship registered?

Yes

+ Add another domestic relationship

Yes

Partner's given name(s)

Partner's family name

Partner's sex

Male

Female

Was the relationship registered?

Yes

Children

Did the person who has died have any children?

Yes

Please specify each child’s details:

Child Information

Click on + (Plus) icon to add more child

Surname (family name)

Given name(s)

Date of Birth

Parents

Births, Deaths and Marriages also require information about the parents of the person who has died. Please provide as much information as you can, providing it is accurate.

Mother / Parent

Name

Surname (family name) Given name(s) Surname at birth

Usual occupation during their working life

Date of birth

Month

Day

Year

Father / Parent

Name

Surname (family name) Given name(s) Surname at birth

Usual occupation during their working life

Date of birth

Month

Day

Year

Family information

Was the person who died under 18 years of age?

Yes

Did they have any siblings?

Yes

Please specify each sibling’s details:

Siblings

Click on + (Plus) icon to add more siblings

Surname (family name)

Given name(s)

Date of Birth

Place of Birth

Applying for the cremation

About the cremation application
We need the following information to help us complete the documentation required for the cremation. These questions are about you, the person completing this form, unless otherwise stated.

Are you the nearest surviving relative of the person who has died?

Yes

Unsure

Are you an executor of their estate?

Yes

Unsure

Have all near relatives been notified of the proposed cremation?

Yes

Unsure

Are you aware of any disagreement, dispute or other person who may object to the cremation or your role as the Responsible Person?*

Yes

Unsure

Did the person who has died leave any written or verbal directive regarding their funeral wishes?

Yes

Unsure

Please provide details:

Do you have any reason to suspect that the death was not natural, or that an examination of the person's body may be required?

Yes

Unsure

Please provide details:

Medical information

Please provide the following information about the person's medical care, where known.

Usual doctor

Name of their usual medical practitioner

Practice/address

Street Address City State / Province / Region ZIP / Postal Code Country

Doctor who attended their last illness

Name of the medical practitioner(s) who attended them during their last illness

Practice/address

Street Address City State / Province / Region ZIP / Postal Code Country

Battery-powered devices

Did the person have a pacemaker or any other battery-powered medical device?

Yes

Unsure

Please tell us what type of device, if known.

Supporting Documents

Please prepare the supporting documents. This might include birth certificates, Grant of Probate. We will follow up for the documents.

Final Confirmation

I,(Required)

confirm that I have reviewed the information in this form and, to the best of my knowledge, it is complete and accurate. I understand that Fixed Price Cremations will rely on the information I have provided when registering the death with Births, Deaths and Marriages, and that any inaccuracies in the information I provide may also appear on the death certificate.

Confirmation

I have reviewed the information above and believe it is accurate to the best of my knowledge.

Confirmation

I confirm that I am the Responsible Person for these arrangements.

Signature

Your Name
Your Name
Your Name

Before completing this form

Please check the information you've provided is accurate, including factual information and spelling, before submitting this form. Names, dates, places and family information should be as accurate as possible, as some of these details will be provided to Births, Deaths and Marriages to register the death.
If there is something you are unsure about, please contact our team on 1300 262 797.

Register a Death

Your Details

Details of the person who has passed away

Details of their death

Personal details

Relationships

Marriage history

Marriage 1

Marriage 2

Domestic relationship history

Please provide details of their domestic relationship or relationships

Children

Please specify each child’s details:

Parents

Mother / Parent

Father / Parent

Family information

Please specify each sibling’s details:

Applying for the cremation

Medical information

Supporting Documents

Final Confirmation

Before completing this form