Vital Statistics

This is information required to complete necessary government paperwork.

Last Name of the Deceased*
First Name(s) of the Deceased*
Middle Names of the Deceased
Sex*
- Male
- Female
Date of Birth of the Deceased

DD
MM
YYYY
City and Province where the Deceased was born (if outside of Canada, state the country)
Age
Deceased's Address
Street Address City Province Postal Code
Marital or Relationship Status of the Deceased
- Single
- Married
- Widowed
- Divorced
- Common-law
- Same-sex Partner
Full Name of the Deceased's Spouse (LEGAL Name before this relationship - DOE: Jane Marie, where DOE is the Maiden Name)
Type of work done for most of working life
Type of business or industry that the deceased worked in for most of working life
Name of the Deceased's FATHER (LAST: FIRST, MIDDLE)
Birthplace of the Deceased's FATHER (if outside Canada, state the country)
Name of the Deceased's MOTHER (LAST (MAIDEN): FIRST, MIDDLE)
Birthplace of the Deceased's MOTHER (if outside Canada, state the country)
Information About You
Your Full Name
How are you related to the deceased?
- Spouse
- Child
- Parent
- Sibling
Your Address
- Is the same address as the deceased
- Different address
Your Address (please include PO Box Number, if applicable)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email (IF SUBMITTED, YOU WILL RECEIVE AN AUTOMATED EMAIL WITH THE INFORMATION SUBMITTED AND INFORMATION STILL NEEDED)
Phone
Comments
This field is for validation purposes and should be left unchanged.