Statistical Information

Deceased Details

* Indicates required field

Surname *

First Names *

Full Name at Birth If Different *

Date of Birth *

Usual Residential Address *

Country of Birth *

Gender *

Place of Birth (Town/City) *

If Not Born in NZ Year of Arrival *

Profession / Occupation (Longest or Last) *

Did they have a title? (JP, OBE etc) *

Did they hold an Honour or Award? (do not include military decorations) *

Mother's Details

Mother's Surname *

Mother's First Names *

Mother's Maiden Name *

Mother's Occupation *

Father's Details

Father's Surname *

Father's First Names *

Father's Occupation *

Children

Age(s) of Living Daughters *

Age(s) of Living Sons *

Marriage Details

Marital Status at time of death *

Enter Most Recent

Spouse Full Name *

Current Age of Spouse *

Country of Marriage *

Gender *

Age of Deceased at time of Marriage *

City of Marriage *

Second Most Recent

Spouses Full Name *

Gender *

Current Age of Spouse *

Age of Deceased at Time of Marriage *

Country of Marriage *

City of Marriage *

Third Most Recent

Spouses Full Name *

Current Age of Spouse *

Country of Marriage *

Gender *

Age of Deceased at Time of Marriage *

City of Marriage *

Executor Details

Full Name of Executor *

Executor's Address *

Executor's Contact Details *

Lawyer's Details

Lawyer's Name *

Lawyer's Company Name *

Lawyer's Contact Details *

Details of the person completing form

Your Surname *

Your First Name *

Your Relationship to the deceased *

Your Address *

Your Occupation *

Your Email Address *

Contact Number *

Mobile Number *

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