Form SS293, Advice of death Completed Form Examples and Samples

Subject: Notification of Service - John Arthur Smith (Passed 14 January 2026)

Dear Registry Office,

I am writing to formally provide details regarding the recent passing of our client, Mr. John Arthur Smith, born on 12 May 1945. John passed away peacefully at St. Jude’s Hospital on 14 January 2026. He was a resident at 42 Maple Street, Unit 4, Springvale, 3171. His Medicare number was 4567 89123 1, reference digit 2. For administrative records, John was single and not of Aboriginal or Torres Strait Islander descent. He did not participate in any child support schemes.

As the executor of his estate, I am his nephew, Mr. Robert Thomas Smith. I live at 15 Oak Lane, Glen Waverley, 3150, and you can reach me at 0412 345 678. I have decided that I will not be requesting additional personal information from Services Australia at this time. 

Our funeral arrangements are being managed by Evergreen Funerals, located at 88 Cemetery Road, Melbourne, 3000. You can reach the director, Sarah Jenkins, at 03 9999 8888. Please consider this email as the formal notification required. I have attached the death certificate and the necessary identification copies. I am available should you require any further documentation to finalize the estate proceedings. The funeral service is scheduled for next Tuesday, and we are working closely with the parish to ensure all paperwork is handled before the burial.

Regards,

Robert T. Smith