SA Death Certificate – Application Form Step 1 of 8 12% Did the death occur in South Australia? The Registry office only issues certificates for events that have occurred in South Australia. Please refer to the relevant interstate or overseas Registry if your event occurred interstate or overseas e.g. you were born interstate.Please confirm the death occurred in South Australia(Required) Yes, In South Australia No, Interstate or Overseas This Registry only records events that occurred in South Australia. Please contact the relevant interstate or overseas Registry to obtain your certificate. Disclosure of informationWhen you make this application, understand that you have consented to the release of information provided by you to those Agencies that may choose to validate the information in support of your application. It is extremely important that all your identity documents are accurate and reflect your correct identity information. When you complete this application, documents provided as proof of identity may have their authenticity verified through the Online National Document Verification Service (DVS). Documents issued by this office may also be verified by other organisations using the DVS.(Required) Please confirm you have read the disclosure of information How to verify your identityYou will need to upload scanned or photographed images of the following identity documents. At least one document must show your name and postal address and one document must show your signature. All documents must be current (not expired). Where a secondary document is provided as evidence of your postal address and it has an issue date, it must have been issued within the last three month period. Option 1 Australian driver’s licence OR Centrelink concession card OR an Australian passport AND one secondary identity document. Option 2 Medicare card AND two secondary identity documents. Option 3 (overseas residents only) Overseas passport OR overseas driver’s licence AND two secondary identity documents. If your identity documents are in another language, they must be translated into English by an accredited translator.(Required) Please confirm you have the required identity documents Death Certificate detailsSurname(Required)Full Given Names(Required)Date Of Death(Required) Day Month Year Place of Death(Required)Reason For The Certificate(Required)Select a reasonBank AccountBushfireCentrelinkChange Of NameData BreachDivorceDrivers LicenceEmploymentEstateFamily HistoryIdentificationImmigration/Foreign MarriageLegal/CourtLost PreviousMarriageMarriage NOIMMedicareNaturalisationNew RelationshipPassportPersonalPolicePolice ClearanceProof Of AgeRevoke RelationshipSchool/EducationSecurity ClearanceSports RegistrationTax File NumberRelation (I am the...)(Required)Please selectAuntAuthorised AgentBrotherChildCo-ParentDefacto SpouseFamily HistorianFatherFriendFuneral DirectorGrandchildGrandfatherGrandmotherGuardianMotherOtherOther KinSisterSpouseStep-ChildStep-ParentUncleFAILED ACCESS POLICY You can only apply for this death certificate if you provide written authorisation from the subject person's spouse, de facto partner, registered partner, parent or child. To provide written authorisation, select the 'Authorised Agent' relation and upload the required documents. AuthorisationAs a guardian, you are required to upload a court order that allocates guardianship.(Required)Max. file size: 3 MB. AuthorisationAs an authorised agent, you are required to upload documents proving your authority to apply for this certificate.Document 1 Complete and upload a signed authority to supply a certificate document to prove you have authority to apply for this certificate. Click here to download authority formUpload document 1(Required)Max. file size: 3 MB. You must upload two forms of identification for the person giving you authority to apply for this certificate. At least one document must show name and address and one document must show signature.Upload document 2(Required)Max. file size: 3 MB. Upload document 3(Required)Max. file size: 3 MB. Applicant Details - information about youPlease ensure your details match those on your identity documentsTitleSurname(Required)Given Names(Required)Date Of Birth(Required) Day Month Year Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Email(Required) Phone(Required) Please upload three different types of identity documents. Make sure to select a different option in each of the three upload sections to help us verify your identity.Choose Identity Document 1(Required)Please selectAviation Id CardDriver's Licence (Aust)Health Concession CardMaritime Id CardMedicare CardPassport (Aust)Pension Concession CardSeniors Health Concession CardCard Number(Required)Expiry Date(Required) Day Month Year State Of Issue(Required)SAACTNSWNTQLDTASVICWALicence Number(Required)Expiry Date(Required) Day Month Year Card Number(Required)Card Number(Required)Expiry Date(Required) Day Month Year Maritime Id Card Number(Required)Expiry Date(Required) Day Month Year Card Number(Required)Expiry Date(Required) Day Month Year Reference No (IRN)(Required)Card Colour(Required)Please selectGreenBlueYellowPassport Number(Required)Card Number(Required)Expiry Date(Required) Day Month Year Upload Identity Document 1(Required)Max. file size: 3 MB. Choose Identity Document 2(Required)Please selectATO Assessment NoticeAcademic Uni Transcript (Certified)Aviation Id CardBank/Credit Union StatementCouncil Rate NoticeDriver's Licence (Aust)Electoral Commission EnrolmentGovernment Photo IdHealth Concession CardHome Insurance PapersMaritime Id CardMedicare CardMortgage DocumentsMotor Vehicle Reg PapersOverseas Drivers LicenceOverseas PassportPassport (Aust)Pension Concession CardProof of Age CardSecurity Guard LicenceSeniors Health Concession CardStudent Id Card (Sec/Tert)Superannuation Fund StatementTelephone/Mobile AccountTenancy/Lease AgreementUtilities AccountState Of Issue(Required)SelectSAACTNSWNTQLDTASVICWALicence Number(Required)Card Number(Required)Maritime Id Card Number(Required)Expiry Date(Required) Day Month Year Reference No (IRN)(Required)Card Colour(Required)GreenBlueYellowPassport Number(Required)Upload Identity Document 2(Required)Max. file size: 3 MB. Choose Identity Document 3(Required)Please selectATO Assessment NoticeAcademic Uni Transcript (Certified)Aviation Id CardBank/Credit Union StatementCouncil Rate NoticeDriver's Licence (Aust)Electoral Commission EnrolmentGovernment Photo IdHealth Concession CardHome Insurance PapersMaritime Id CardMedicare CardMortgage DocumentsMotor Vehicle Reg PapersOverseas Drivers LicenceOverseas PassportPassport (Aust)Pension Concession CardProof of Age CardSecurity Guard LicenceSeniors Health Concession CardStudent Id Card (Sec/Tert)Superannuation Fund StatementTelephone/Mobile AccountTenancy/Lease AgreementUtilities AccountState Of Issue(Required)SelectSAACTNSWNTQLDTASVICWALicence Number(Required)Card Number(Required)Maritime Id Card Number(Required)Expiry Date(Required) Day Month Year Reference No (IRN)(Required)Card Colour(Required)GreenBlueYellowPassport Number(Required)Upload Identity Document 3(Required)Max. file size: 3 MB. Please confirm one of your documents CLEARLY shows your signature(Required)Please selectYesNoDoes one of your documents show your postal address?(Required)Please selectYesNo Credit or Debit CardConfiguration Required: To use the Stripe field, please configure your Stripe Settings. Price $129.00 This price includes application management, processing and assistance costs, government fees and taxes. (Required) I have read, understood and accept the privacy policy and the terms and conditions.
