Details needed for Death Certificate

This information is required for the official death certificate, so that the estate can be administered. If you would prefer to not disclose any information, or it is unknown, please mark it as 'not recorded'.

We are here to help so please feel free to ring us if you have any questions.

Please fill out this form and post it to Ninness Funeral home or send it directly to us by clicking the button at the bottom of the page.

*An asterisk indicates a compulsory field

Deceased
* First or given name(s)
* Surname or family name
Name at birth (if different from above)
Sex	Male Female
Date of death
Place of death
Date of birth
Age Now
Place of birth
Years in NZ
Address
Occupation
Ethnicity
Ethnic Group	NZ Maori New Zealand European/Pakeha Dutch English Australian Scottish Irish Samoan Cook Island Maori Tongan Tokelauan Niuean Chinese Indian
Other Ethic Group
Was deceased descended from NZ Maori?	Yes No
Children
Age of each living son
Age of each living daughter
Parents
Mother's full name
Mother's maiden name
Mother's occupation
Father's full name
Surname at birth if different
Father's occupation
Relationship Details of Deceased:
Relationship status at time of death	Married In a civil union Marriage or civil union dissolved In a de facto relationship Spouse or partner deceased Seperated from de facto relationship Permanently seperated Has never been in a legal relationship
Details of Most Recent Relationship
Details of most recent relationship	Married In a civil union In a de facto relationship
Place of marriage or civil union
Country of marriage or civil union (if not NZ)
Age of deceased at marriage or civil union
Spouse/Partner: Full Name (When Relationship Formalised)
First or given name(s)
Surname or family name
Sex of Spouse/Partner and Their Age if Living
Sex	Male Female
Age
Details of Second Most Recent Relationship
Details of most recent relationship	Married In a civil union In a de facto relationship
Place of marriage or civil union
Country of marriage or civil union (if not NZ)
Age of deceased at marriage or civil union
Spouse/Partner: Full Name (When Relationship Formalised)
First or given name(s)
Surname or family name
Sex of Spouse/Partner and Their Age if Living
Sex	Male Female
Age
Do any of the following apply to the deceased?
	Justice of the Peace Marriage Celebrant Hold an honour or award
Name of honour(s) or award(s)
Your Contact Details
* Your Name
* Your Street Address
* Your Phone Number
Your Email Address

Home | Planning a Funeral | About us | Funeral Choices | Ninness Team | Registration of Death | Contact | Sitemap | Resources

© Copyright 2007-2010 Ninness Funeral Home

Website design and web development by Altered Ego Design Ltd
New Zealand Website Designers | Wellington