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Application For Death Certificate: Department of Home Affairs

This document is an application form for a death certificate from the Department of Home Affairs in South Africa. It requests details about the deceased individual such as their identity number, date and place of birth, date and place of death. It also requests details about the applicant such as their name, identity number, and contact information. The applicant must select whether they need an unabridged certificate, computer printed certificate, or certified copy of the death register. The form notes it must be submitted in person at a regional or district office along with the required fee.

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Beyza Gemici
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311 views1 page

Application For Death Certificate: Department of Home Affairs

This document is an application form for a death certificate from the Department of Home Affairs in South Africa. It requests details about the deceased individual such as their identity number, date and place of birth, date and place of death. It also requests details about the applicant such as their name, identity number, and contact information. The applicant must select whether they need an unabridged certificate, computer printed certificate, or certified copy of the death register. The form notes it must be submitted in person at a regional or district office along with the required fee.

Uploaded by

Beyza Gemici
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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G.P.-S.

017-0064 BI 132

REPUBLIC OF SOUTH AFRICA


DEPARTMENT OF HOME AFFAIRS

APPLICATION FOR DEATH CERTIFICATE

This form must be handed in at a Regional or District office of the Department of Home Affairs together with the prescribed fee.

THE REASON WHY THE CERTIFICATE IS REQUIRED MUST BE SUBMITTED [In terms of section 29 of the
Births and Deaths Registration Act, 1992 (Act No. 51 of 1992)]
.............................................................................................................................................................................................

.............................................................................................................................................................................................
For use in the Republic of South Africa a computer printed certificate of death particulars is normally issued. Such a
certificate complies with the requirements for which a death certificate is required. An unabridged certificate is available
and is issued mainly for overseas use. Indicate with an X which document is required.

Unabridged certificate Computer printed certificate Certified copy of register

A. PARTICULARS OF DECEASED
Y M D
1. Identity Number 2. Date of birth

3. Surname

4. Maiden name if married woman 5. Place of birth

6. Forenames in full

Y M D
8. Death entry number
7. Date of death (Must be completed by
regional or district office)

9. Town/City of death 10. Province

11. Name of undertaker

B. PARTICULARS OF APPLICANT

1. Surname

2. Initials 3. Identity number

4. Residential address

5. Postal address

6. Postal address code

Telephone number (Work) Telephone code

Telephone number (Home) Telephone code

............................................................................... ...............................................................................
Signature Date

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