Register Death with Department of Vital Statistics

Fields marked with an * are required

Full legal name of the deceased*:

Last address of the deceased*:

Date of Birth*:

Place of Birth*:

Date of Death*:

Place of Death*:

SIN*:

Occupation (Majority of life)*:

Deceased mothers name and birth place*:

Deceased fathers name and birth place*:

Mothers Maiden Name*:

Marital Status*:

Never Married

Married

Widowed

Divorced

Seperated

Spouse's Full Name*:

Spouse's Maiden Name*:

Next of Kin: Full Name*:

Next of Kin : Address*:

Next of Kin : Phone*:

Next of Kin : Postal Code*:

Next of Kin : Email*:

SECURITY QUESTION : What year is it ?*:

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Vital Stats Information