Form SA472, Advice of death Instructions
This form contains 144 fields organized into 43 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Aboriginal or Torres Strait Islander Descent | ||
| No | Checkbox |
Check this box if the person was not of Aboriginal or Torres Strait Islander Australian descent.
|
| DummyCalcQ9Atsi | Text | |
| Yes - Aboriginal Australian | Checkbox |
Check this box if the person was of Aboriginal Australian descent.
|
| Yes - Torres Strait Islander Australian | Checkbox |
Check this box if the person was of Torres Strait Islander Australian descent.
|
| Are Next of Kin Details Known | ||
| Q29_No | CheckBox | |
| Yes | Checkbox |
Check this box if the next of kin details are known.
|
| Australian South Sea Islander Descent | ||
| No | Checkbox |
Check this box if the deceased person was not of Australian South Sea Islander descent.
|
| Yes | Checkbox |
Check this box if the deceased person was of Australian South Sea Islander descent.
|
| Centrelink Reference Number | ||
| Centrelink Reference Number Part 1 | Text |
Please enter the first part of the Centrelink Reference Number.
|
| Centrelink Reference Number Part 2 | Text |
Please enter the second part of the Centrelink Reference Number.
|
| Centrelink Reference Number Part 3 | Text |
Please enter the third part of the Centrelink Reference Number.
|
| Centrelink Reference Number Part 4 | Text |
Please enter the fourth part of the Centrelink Reference Number.
|
| Child Support Reference Number | ||
| Child Support Reference Number Part 1 | Text |
Enter the first part of the Child Support Reference Number.
|
| Child Support Reference Number Part 2 | Text |
Enter the second part of the Child Support Reference Number.
|
| Child Support Reference Number Part 3 | Text |
Enter the third part of the Child Support Reference Number.
|
| Child Support Reference Number Part 4 | Text |
Enter the fourth part of the Child Support Reference Number.
|
| Child Support Status | ||
| No | Checkbox |
Check this box if the deceased person did not receive child support for a child in their care and did not pay child support.
|
| DummyCalcQ11 | Text | |
| Not sure | Checkbox |
Check this box if you are unsure whether the deceased person received child support for a child in their care or paid child support.
|
| Yes | Checkbox |
Check this box if the deceased person either received child support for a child in their care or paid child support.
|
| Child(ren)'s Current Address | ||
| Address Line 1 | Text |
Provide the first line of the child(ren)'s current residential address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Provide the second line of the child(ren)'s current residential address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Suburb/Town/City | Text |
Provide the suburb, town, or city of the child(ren)'s current residential address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Provide the postcode of the child(ren)'s current residential address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Date of Death | ||
| Day of Death | Number |
Please enter the day of the deceased person's death.
|
| Month of Death | Number |
Please enter the month of the deceased person's death.
|
| Year of Death | Number |
Please enter the year of the deceased person's death.
|
| Deceased Person's Date of Birth | ||
| Day of Birth | Text |
Enter the day the deceased person was born.
|
| Month of Birth | Text |
Enter the month the deceased person was born.
|
| Year of Birth | Text |
Enter the year the deceased person was born.
|
| Deceased Person's Home Address | ||
| Street Address Line 1 | Text |
Please provide the first line of the deceased person's street address.
|
| Street Address Line 2 | Text |
Please provide the second line of the deceased person's street address.
|
| Suburb/City/State | Text |
Please provide the suburb, city, or state of the deceased person's home address.
|
| Postcode | Text |
Please provide the postcode of the deceased person's home address.
|
| Deceased Person's Title and Name | ||
| Mr | Checkbox |
Check this box if the deceased person's title is Mr.
|
| Mrs | Checkbox |
Check this box if the deceased person's title is Mrs.
|
| Miss | Checkbox |
Check this box if the deceased person's title is Miss.
|
| Ms | Checkbox |
Check this box if the deceased person's title is Ms.
|
| Mx | Checkbox |
Check this box if the deceased person's title is Mx.
|
| Deceased Person's Other Title | Text |
Please provide the deceased person's title if it is not listed in the options above. Fill only if 'Mx' is 'Yes'.
Depends on:
Mx
|
| Deceased Person's Family Name | Text |
Please provide the deceased person's family name.
|
| Deceased Person's First Given Name | Text |
Please provide the deceased person's first given name.
|
| Deceased Person's Second Given Name | Text |
Please provide the deceased person's second given name.
|
| Declaration Date | ||
| Declaration Day | Date |
Please enter the day of the declaration.
|
| Declaration Month | Date |
Please enter the month of the declaration.
|
| Declaration Year | Date |
Please enter the year of the declaration.
|
| Declarer's Full Name | ||
| Declarer's Full Name | Text |
Please provide your full name as the declarer.
|
| Declarer's Signature | ||
| Declarer's Signature | Text |
Provide your signature to declare that the information provided in the form is complete and correct.
|
| Executor/Administrator Contact Phone Number | ||
| Executor/Administrator Contact Phone Number | Text |
Provide the contact phone number for the executor or administrator, including the area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Executor/Administrator Details Known | ||
| No | Checkbox |
Check this box if the executor or administrator of the estate's details are not known.
|
| DummyCalcQ23 | Text | |
| Yes | Checkbox |
Check this box if the executor or administrator of the estate's details are known.
|
| Executor/Administrator Information Request | ||
| No | Checkbox |
The user should check this box if the executor or administrator will not be requesting information from Services Australia.
|
| Not sure | Checkbox |
The user should check this box if they are not sure whether the executor or administrator will request information from Services Australia.
|
| Yes | Checkbox |
The user should check this box if the executor or administrator will be requesting information from Services Australia.
|
| Executor/Administrator Name | ||
| Executor Family Name | Text |
Please provide the family name of the executor or administrator. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Executor First Given Name | Text |
Please provide the first given name of the executor or administrator. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Executor/Administrator Organisation Name | ||
| Organisation Name | Text |
Provide the full name of the organization for the executor or administrator, if applicable. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Executor/Administrator Postal Address | ||
| Address Line 1 | Text |
Enter the first line of the executor or administrator's postal address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Enter the second line of the executor or administrator's postal address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 3 | Text |
Enter the third line of the executor or administrator's postal address, typically including the city or town. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Enter the postcode for the executor or administrator's postal address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Executor/Administrator Title | ||
| Title2_Mr | CheckBox |
Depends on:
Yes
|
| Title2_Mrs | CheckBox |
Depends on:
Yes
|
| Title2_Miss | CheckBox |
Depends on:
Yes
|
| Title2_Ms | CheckBox |
Depends on:
Yes
|
| Title2_Mx | CheckBox |
Depends on:
Yes
|
| Other Title | Text |
Provide the specific title of the executor or administrator if it is not one of the standard options. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Funeral Details Known | ||
| No | Checkbox |
Check this box if the funeral director's details are not known.
|
| DummyCalcQ18 | Text | |
| Yes | Checkbox |
Check this box if the funeral director's details are known.
|
| Funeral Director's Business Address | ||
| Address Line 1 | Text |
Please provide the first line of the funeral director's business address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Please provide the second line of the funeral director's business address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Please provide the postcode for the funeral director's business address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Funeral Director's Business Name | ||
| Business Name | Text |
Please provide the full legal name of the funeral director's business. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Funeral Director's Contact Name | ||
| Q22 | Text |
Depends on:
Yes
|
| Funeral Director's Contact Phone Number | ||
| Funeral Director Contact Phone Number | Text |
Please enter the funeral director's contact phone number, including the area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| General | ||
| Instructions | Button | |
| Instructions | Button | |
| Q11GoToQ13a | Button | |
| Q11GoToQ13b | Button | |
| Q13GoToQ18a | Button | |
| Q13GoToQ18b | Button | |
| Q18GoToQ23 | Button | |
| Q20.Address1 | Text | |
| Q20.Address2 | Text | |
| Q23GoToQ29 | Button | |
| DummyCalcQ29 | Text | |
| Q29GoToQ34 | Button | |
| Q37.Address1 | Text | |
| Q37.Address2 | Text | |
| Clear | Button | |
| Hospital Address | ||
| Hospital Address Line 1 | Text |
Enter the first line of the hospital's street address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hospital Address Line 2 | Text |
Enter the second line of the hospital's street address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hospital Address Line 3 | Text |
Enter the third line of the hospital's street address, such as the city or town. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hospital Postcode | Text |
Enter the postcode for the hospital's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hospital Contact Name | ||
| Contact Name | Text |
Please provide the full name of the contact person at the hospital. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hospital Contact Phone Number | ||
| Hospital Contact Phone Number | Text |
Please provide the contact phone number for the hospital, including its area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hospital Details Known | ||
| Not applicable | Checkbox |
Check this box if hospital details are not applicable.
|
| Hospital Details Known | Text |
Please indicate whether the hospital details are known.
|
| No | Checkbox |
Check this box if hospital details are not known.
|
| Yes | Checkbox |
Check this box if hospital details are known.
|
| Hospital Name | ||
| Hospital Name | Text |
Provide the full name of the hospital. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Medicare Card Number | ||
| Medicare Card Number Part 1 | Text |
Enter the first part of the Medicare card number.
|
| Medicare Card Number Part 2 | Text |
Enter the second part of the Medicare card number.
|
| Medicare Card Number Part 3 | Text |
Enter the third part of the Medicare card number.
|
| Medicare Card Reference Number | Text |
Enter the reference number associated with the Medicare card.
|
| Next of Kin's Address | ||
| Address Line 1 | Text |
Please enter the first line of the next of kin's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Please enter the second line of the next of kin's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 3 | Text |
Please enter the third line of the next of kin's address, which may include suburb, city, and state. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Please enter the postcode for the next of kin's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Next of Kin's Contact Phone Number | ||
| Next of Kin Phone Number | Text |
Please provide the contact phone number for the next of kin, including the area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Next of Kin's Name | ||
| Mr | Checkbox |
Check this box if the next of kin's title is 'Mr'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Mrs | Checkbox |
Check this box if the next of kin's title is 'Mrs'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Miss | Checkbox |
Check this box if the next of kin's title is 'Miss'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Ms | Checkbox |
Check this box if the next of kin's title is 'Ms'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Mx | Checkbox |
Check this box if the next of kin's title is 'Mx'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Title | Text |
Please provide the specific title if 'Mr', 'Mrs', 'Miss', 'Ms', or 'Mx' do not apply. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Family Name | Text |
Please enter the family name of the next of kin. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Given Name | Text |
Please enter the first given name of the next of kin. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Next of Kin's Relationship to Deceased Person | ||
| Relationship to Deceased Person | Text |
Please provide the next of kin's relationship to the deceased person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Notifier's Contact Phone Number | ||
| Contact Phone Number | Text |
Please provide the notifier's contact phone number, including the area code.
|
| Notifier's Name | ||
| Mr | Checkbox |
Check this box if the notifier's title is Mr.
|
| Mrs | Checkbox |
Check this box if the notifier's title is Mrs.
|
| Miss | Checkbox |
Check this box if the notifier's title is Miss.
|
| Ms | Checkbox |
Check this box if the notifier's title is Ms.
|
| Mx | Checkbox |
Check this box if the notifier's title is Mx.
|
| Notifier's Other Title | Text |
Please provide any other title or honorific for the notifier not listed in the options.
|
| Notifier's Family Name | Text |
Please enter the notifier's family name.
|
| Notifier's First Given Name | Text |
Please enter the notifier's first given name.
|
| Notifier's Postal Address | ||
| Notifier's Street Address | Text |
Please provide the notifier's street address details.
|
| Notifier's Suburb or Locality | Text |
Please provide the notifier's suburb or locality.
|
| Notifier's Postcode | Text |
Please provide the notifier's postal code.
|
| Notifier's Relationship to Deceased Person | ||
| Relationship to Deceased Person | Text |
Enter your relationship to the deceased person.
|
| Organisation Name | ||
| Organisation Name | Text |
Please provide the name of the organisation.
|
| Relationship Details | ||
| Single | Checkbox |
Check this box if the person's relationship status is single.
|
| Married | Checkbox |
Check this box if the person's relationship status is married.
|
| Registered | Checkbox |
Check this box if the person's relationship status is registered, indicating a formal registration of their relationship.
|
| Partnered | Checkbox |
Check this box if the person's relationship status is partnered, indicating they are in a de facto or similar relationship.
|
| Widowed | Checkbox |
Check this box if the person's relationship status is widowed.
|
| Separated | Checkbox |
Check this box if the person's relationship status is separated from their spouse or partner.
|
| Divorced | Checkbox |
Check this box if the person's relationship status is divorced.
|
| Not sure | Checkbox |
Check this box if the person's relationship status is unknown.
|
| Partner's Name | Text |
Provide the full name of the partner, if applicable. Fill only if 'Married', 'Registered', 'Partnered', 'Widowed', 'Separated' is 'Yes', any.
Depends on:
Married, Registered, Partnered, Widowed, Separated
|