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BDM Registry Form

The purpose of the BDM Registry form is to gather all information needed to organise your loved ones certification of death.

"*" indicates required fields

Name of Deceased*

Name at Birth

(if different from name at time of death)

Date of Death*

Where Died*

Usual Home Address*

Age*

Date of Birth*

Place of Birth*

Years Lived in New Zealand*

Mother's Full Name*

Mother's Maiden Name*

Mother's Profession*

Father's Full Name*

Father's Profession*

Martial Status

Legal Status*

Current Marriage Details

Spouses Full Name*

Surname

Maiden Name

Spouses Date of Birth*

Age of Deceased at Marriage*

Date of Marriage*

Where Married*

Any Previous Marriages?*

Previous Marriage Details

First Marriage

Spouses Full Name*

Surname

Maiden Name

Spouses Date of Birth*

Age of Deceased at Marriage*

Date of Marriage*

Where Married*

More Marriages?*

Second Marriage

Spouses Full Name*

Surname

Maiden Name

Spouses Date of Birth*

Age of Deceased at Marriage*

Date of Marriage*

Where Married*

Add More Marriages?*

Marriage Details*

Please list the spouses full name, surname (maiden name), spouses date of birth, age of deceased at marriage, date of marriage, and where married for all additional marriages not already listed above

About Desceased

Any Children?*

Age of Daughters*

Age of Sons*

Ethnic Group*

Ethnicity*

Descended From NZ Maori*

Is Deceased a Marriage Celebrant?*

Is Deceased a Justice of the Peace?*

Did Deceased Hold Awards/Honour?*

What Awards/Honour?*

Did Deceased Serve in the Military?*

Rank*

Service (RSA) Number*

Company*

Flag*

RSA in Attendance?*

Clubs Guard of Honour*

Next of Kin

Name*

Relationship*

Address*

Phone Number

Mobile*

Home

Work

Email Address*

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