WA Death Certificate – Application Form Step 1 of 13 7% Applicant detailsSurname(Required)Given names(Required)Phone(Required)Please include country code if outside AustraliaEmail(Required) As a Tax Invoice will be sent to this email address please ensure it is correctYour residential addressAddress(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 Postal addressAddress(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 Was the death registered in Western Australia(Required) Yes No Death certificates are only available if the death was registered in Western Australia. Please contact the state or country where the death was registered.Are you the Parent, Child or Spouse of the deceased?(Required) Yes No Letter of Authority required If applying on behalf of another person, a Letter of Authority or other evidence of entitlement may be required. For further information the RBDM Certificate Access Policy can be viewed at WA.gov.auWhy do you need the certificate?(Required)Please selectBank requirementsEstateFamily historyInsuranceLegalPassportProperty settlementSuperannuationOtherPlease state the reason you require the certificate(Required) Death detailsPlease complete the form below:Surname of deceased(Required)Given names of deceasedDate of death(Required) Day Month Year Place of death (Suburb/Town) Select your identity documentsWhen applying for a Western Australian certificate, evidence of your identity must be provided. For overseas applicants, the Registry will consider equivalent overseas documents. Please ensure that you have these documents before continuing.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 document 1(Required)Please selectAustralian driver's licenceAustralian passportAustralian firearms licenceDefence Force/Police Identification CardAustralian citizenship certificateWestern Australia Photo Card, Over 18 or Proof of Age CardAustralian learner driver's permit CardChoose document 2(Required)Please selectDocument of identity (issued by the passport office)Entitlement Card (eg Centrelink, Health Care Card, Veteran Card)ImmiCardAustralian Birth Certificate (birth extracts not accepted)Medicare cardNaturalisation, Citizenship or Immigration papers (issued by the Department of Home Affairs)Overseas passport (with current Australian Entry Permit)Australian Security guard or Crowd Control LicenceStudent identity document or Statement of EnrolmentWorking With Children CardChoose document 3(Required)Please selectDriver's licence renewal noticeFinancial institution statement (less than six months old)Motor vehicle registrationProperty lease or tenancy agreementShire/water rates noticeSchool or other educational report or certificate (less than 12 months old)Utility account (eg gas, electricity, telephone less than six months old) Australian driver's licence(MUST provide copy of front and back)Licence number(Required)Driver's licence card number (located on front or back of card)(Required)Surname(Required)Given name(Required)Middle nameDate of birth(Required) Day Month Year Select a state(Required)Please selectAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaUpload your identity images You must upload images of the selected documents by choosing either: One image containing all original documents One image for each document Multiple images (one at a time) for the same original document (eg front and back of Australian driver's licence) Upload Australian driver's licence(Required) Drop files here or Select files Max. file size: 2 GB. Australian passportYou are required to provide your document detailsSurname(Required)Given names(Required)Date of birth(Required) Day Month Year Travel document number(Required)Upload your identity images You must upload images of the selected documents by choosing either: One image containing all original documents One image for each document Multiple images (one at a time) for the same original document (eg front and back of Australian driver's licence) Upload Australian passport(Required) Drop files here or Select files Max. file size: 2 GB. Australian citizenship certificateYou are required to provide your document detailsFamily name(Required)Given names(Required)Date of birth(Required) Day Month Year Acquisition date(Required) Day Month Year Stock number(Required) Medicare cardYou are required to provide your medicare card detailsCard number(Required)Individual ref number(Required)Full name(Required)Card expiry(Required) Day Month Year Upload your identity imagesYou are required to provide your document detailsYou must upload images of the selected documents by choosing either: One image containing all original documents One image for each document Multiple images (one at a time) for the same original document (eg front and back of Australian driver's licence) Letter of authority(Required) Drop files here or Select files Max. file size: 2 GB. Upload your identity imagesYou are required to provide your document detailsYou must upload images of the selected documents by choosing either: One image containing all original documents One image for each document Multiple images (one at a time) for the same original document (eg front and back of Australian driver's licence) Upload document 1(Required) Drop files here or Select files Max. file size: 2 GB. Upload your identity imagesYou are required to provide your document detailsYou must upload images of the selected documents by choosing either: One image containing all original documents One image for each document Multiple images (one at a time) for the same original document (eg front and back of Australian driver's licence) Upload document 2(Required) Drop files here or Select files Max. file size: 2 GB. Upload your identity imagesYou are required to provide your document detailsYou must upload images of the selected documents by choosing either: One image containing all original documents One image for each document Multiple images (one at a time) for the same original document (eg front and back of Australian driver's licence) Upload document 3(Required) Drop files here or Select files Max. file size: 2 GB. (Required) I confirm that I am authorised to provide the personal details presented and I consent to my information being checked with the document issuer or official record holder via 3rd party systems for the purpose of confirming my identity. Click the checkbox to confirm. Credit CardConfiguration Required: To use the Stripe field, please configure your Stripe Settings. Price $119.00 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.
