Form SA472, Advice of death Completed Form Examples and Samples

Dear Case Officer, I am writing to formally notify you of the passing of my brother, Mr. Arthur James Miller, who sadly died on October 14, 2026. He was born on March 2, 1948. At the time of his passing, he lived at 42 Maple Street, Apartment 3B, Springfield, 2000. He was widowed and not of Aboriginal or Torres Strait Islander descent, nor was he of Australian South Sea Islander descent. Regarding his government details, his Medicare card is 4567 8901 22, reference number 1. We are currently handling his final arrangements through 'Eternal Peace Funerals' located at 12 Funeral Home Way, Melbourne, 3000 (Phone: 03 9999 8888). Since Arthur was not receiving or paying any child support, that section is not applicable. His hospital care was provided by Mercy General Hospital at 500 Health Drive, Melbourne, 3000, and we have confirmed their contact number is 03 1234 5678, with Nurse Sarah Jenkins as the primary point of contact. As his executor, I, Mrs. Linda Susan Miller, residing at 15 Oak Lane, Sydney, 2000, am taking care of his estate matters and will be requesting further information from Services Australia. My phone number is 0400 123 456. As the notifier, I declare that this information is complete and correct as of today, October 20, 2026. Please let me know if you require any further documentation from our side.