ImmiGov Services » Australia » Death Certificate » ACT ACT Death Certificate – Application Form Step 1 of 6 16% About this formPlease note that 80% of certificates will be processed within 15 days of receiving all required documents (not including Australia Post delivery times). Certificates are sent by registered person‐to‐person post and addressed to the applicant. As a result, the applicant will need to produce appropriate identification at the post office in order to collect the certificate. Without that identification, Australia Post will not allow you to collect the certificate.(Required) I have read and understand the Privacy Policy Please be aware the issue of a death certificate is considered with regard to the Access Policy. Depending on your relationship to the deceased, you may need to obtain consent from a person who is authorised to apply for the certificate in accordance with the Access Policy. You will be required to attach the consent form on the Supporting documents page. The Third Party Consent form can be completed online. For further information about accessing birth death and marriage register, please refer to the Births, deaths and marriages certificate access policy (PDF 131KB).Did the death occur in the ACT?(Required) Yes No Access Canberra is only able to produce a certificate if the death occurred in the ACT. If the death occurred in another State or Territory, you will need to apply to the relevant authority in that State or Territory.Was the death registered in the ACT?(Required) Yes No A certificate can only be issued after the registration has been completed. Please contact the funeral director. Death certificate detailsGiven name(s) on certificate(Required)Surname on certificate(Required)Date of death(Required) Day Month Year If you are applying for a certificate relating to an event that occurred recently, please be aware that there may be a delay in the issue of that certificate while the appropriate paperwork about that event is received, processed and the registration created. Access Canberra will complete your application and produce the certificate once the registration is finalised. We appreciate your patience. Please be aware that in consideration of your application, Access Canberra may contact you for additional information.Deceased’s place of birth(Required)If married, age when deceased marriedPlease enter a number from 10 to 150.Place of death(Required) Nursing home Hospital Other Nursing Home(Required)Please selectAdria Village, Stirling ACTAnglicare Assisted Living Facility, Page ACTBaptistCare, Griffith ACTBrindabella Court, Downer ACTBrindabella Gardens Aged Care, Curtin ACTBupa Aged Care, Calwell ACTBupa Aged Care, Stirling ACTBurrangiri Aged Care Plus Respite Centre, Rivett ACTCalvary Haydon Retirement Community, Bruce ACTCarey Gardens, Red Hill ACTGoodwin Village, Farrer ACTGoodwin Village, Ainslie ACTGoodwin Village, Monash ACTJindalee Aged Care Residence, Narrabundah ACTKalparrin Aged Care Facility, Holt ACTKangara Waters Lifestyle Community, Belconnen ACTMorshead Home, Lyneham ACTMountain View Aged Care, Narrabundah ACTPines Living, Farrer ACTRFBI Canberra Masonic Village, Holt ACTSouthern Cross Care, Campbell ACTSouthern Cross Care, Garran ACTOtherOther nursing home(Required)Hospital(Required)Please selectThe Canberra Hospital, Canberra ACTCalvary Hospital, Canberra ACTCentenary Hospital for Women and ChildrenNorth Canberra Hospital, Bruce ACTJohn James Memorial Hospital ACTCalvary John James HospitalWoden Valley Hospital ACTRoyal Canberra Hospital ACTCanberra Community Hospital ACTClare Holland House ACTStreet address of death(Required)Name of building/hospital/park/church etcSuburb(Required)Please selectACTONAINSLIEAMAROOARANDABANKSBARTONBEARDBELCONNENBELCONNEN DBONNERBONYTHONBOOTH DBRADDONBRUCECALWELLCAMPBELLCANBERRA AIRPORTCANBERRA CENT DCAPITAL HILLCASEYCHAPMANCHARNWOODCHIFLEYCHISHOLMCITYCONDERCOOKCOOMBSCOREE DCOTTER RIVER DCRACECURTINDEAKINDENMAN PROSPECTDICKSONDOWNERDUFFYDUNLOPEVATTFADDENFARRERFISHERFLOREYFLYNNFORDEFORRESTFRANKLINFRASERFYSHWICKGARRANGILMOREGIRALANGGORDONGOWRIEGREENWAYGRIFFITHGUNGAHLINGUNGAHLIN DHACKETTHALLHALL DHARRISONHAWKERHIGGINSHOLDERHOLTHUGHESHUMEISAACSISABELLA PLAINSJACKAJERRABOMBERRA DJERVIS BAY DKALEENKAMBAHKINGSTONKOWEN DLATHAMLAWSONLYNEHAMLYONSMACARTHURMACGREGORMACNAMARAMACQUARIEMAJURA DMAWSONMCKELLARMELBAMITCHELLMOLONGLOMOLONGLO VALLEY DMONASHMONCRIEFFMOUNT CLEAR DNARRABUNDAHNGUNNAWALNICHOLLSO'CONNORO'MALLEYOAKS ESTATEOXLEYPADDYS RIVER DPAGEPALMERSTONPARKESPEARCEPHILLIPPIALLIGORED HILLREIDRENDEZVOUS CK DRICHARDSONRIVETTRUSSELLSCULLINSPENCESTIRLINGSTROMLO DSTRATHNAIRNSYMONSTONTAYLORTENNENT DTHARWATHEODORETHROSBYTORRENSTUGGERANONG DTURNERURIARRA VILLAGEWANNIASSAWARAMANGAWATSONWEETANGERAWESTONWESTON CREEK DWHITLAMWODEN VALLEY DWRIGHTYARRALUMLADeceased’s length of residence in Australia(Required)Age at the time of death(Required)Please enter a number from 0 to 150.Number of children of the deceased(Required)Please enter a number from 0 to 50.Deceased’s usual occupation prior to death(Required) Applicant detailsThe applicant is the person applying for the certificate, not the person that the certificate relates to. All certificates are sent by registered person to person post. You will be required to show photographic identification to receive the certificate. Please ensure the applicant name for the certificate is the name that is shown on your photographic identification.TitlePlease selectMrMrsMissMsDrGiven name(Required)Family name(Required)Relationship to person named on certificate(Required) Child Family history Informant Parent Spouse Other You will be required to attach evidence of your family link to the deceased, such as a birth certificate etc. Hint: You can take a photo of the document you wish to upload if you do not have a scanner. This document can then be emailed to a webmail account (e.g. Gmail, Hotmail, Yahoo) to be attached to the form if using a different device.Relationship to deceased(Required)Will you provide(Required) Third party consent Power of attorney or legal need You will be required to attach consent from a person named on the death certificate. The Third Party Consent form can be completed online. For further information about accessing birth death and marriage register, please refer to the Births, deaths and marriages certificate access policy (PDF 131KB). Hint: You can take a photo of the document you wish to upload if you do not have a scanner. This document can then be emailed to a webmail account (e.g. Gmail, Hotmail, Yahoo) to be attached to the form if using a different device.You will be required to attach evidence of power of attorney or legal need. Hint: You can take a photo of the document you wish to upload if you do not have a scanner. This document can then be emailed to a webmail account (e.g. Gmail, Hotmail, Yahoo) to be attached to the form if using a different device.Has your name changed since the death certificate was issued?(Required) Yes No Has the name change/s been registered with ACT Births, Deaths and Marriages?(Required) Yes No You will be required to attach evidence supporting the change of name (e.g. A change of name certificate or marriage certificate). Hint: You can take a photo of the document you wish to upload if you do not have a scanner. This document can then be emailed to a webmail account (e.g. Gmail, Hotmail, Yahoo) to be attached to the form if using a different device.Postal addressAddress(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman 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 SaharaYemenZambiaZimbabweÅland Islands Country Email address(Required) Enter Email Confirm Email Daytime contact numberReason certificate is required(Required)Please selectLost certificateExecutorOtherDo you want your previously issued certificate cancelled?(Required) Yes No Provide a reason(Required) Supporting documentsTips on how to attach documents by using a smartphone: Take a photo of your document with your phone or tablet camera. Make sure the whole page is pictured and readable. Remember to take pictures of all pages including double sided documents. Note: If the text is unreadable in your photo, take another photo but before taking the photo, tap the screen where the text is and it should autofocus to make the text easier to read. Share the photo/s of your document to your webmail app (e.g. Gmail, Hotmail, Yahoo, etc). Open and sign in to your webmail app (e.g. Gmail, Hotmail, Yahoo, etc.). Open the email that has the photos attached and download the attachment. Click ‘Save as’ to confirm where the attachment is saved (you can save it in Downloads if unsure). Return to the SmartForm, to the page where you needed to attach the document and upload the saved attachment. Click the Upload file button, browse to the location you saved your photo to and select the file. Evidence supporting your change of name (e.g. A change of name certificate or marriage certificate)(Required) Drop files here or Select files Max. file size: 10 MB. Please attach evidence of your family link to the deceased, such as a birth certificate etc(Required) Drop files here or Select files Max. file size: 10 MB. Power of attorney or legal need(Required) Drop files here or Select files Max. file size: 10 MB. Identification document 1(Required) Drop files here or Select files Max. file size: 10 MB. Identification document 2(Required) Drop files here or Select files Max. file size: 10 MB. Identification document 3(Required) Drop files here or Select files Max. file size: 10 MB. Attach the Third Party Consent form completed by the bride, groom or partner. The Third Party Consent form can be completed online. For further information about accessing birth death and marriage register, please refer to the Births, deaths and marriages certificate access policy (PDF 131KB).Third party consent(Required) Drop files here or Select files Max. file size: 10 MB. ACT Birth Certificate assistance, management and processing service.Credit or Debit CardConfiguration Required: To use the Stripe field, please configure your Stripe Settings. Certificate type: Death Certificate Delivery time: 2 weeks (approx.) Total AUD 135.00 This price includes application management, processing and assistance costs, government fees and taxes. The certificate will be issued and sent directly by the Access Canberra to the address provided in your application. ⓘ Delivery times may vary depending on government processing and postal services. (Required) I have read, understood and accept the privacy policy and the terms and conditions.