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Online Death Certificate Application Form

Government of Jamaica
Registrar General’s Department

Application for a Certified Copy of Death Certificate

Form DTHREQ
Rev. 2004.3

The more accurate information provided, the better chance for prompt and accurate service.
Fields outlined in red are mandatory.

I hereby apply for         Certified Copy(s) of the Death Certificate issued for:

Deceased’s First Name

Deceased’s Middle Name
 

Deceased’s Last Name

Date of Death
- dd-mm-yyyy format

Sex (Indicate appropriately)
Male  Female 

Place of Death (Hospital, District, Street Address, etc.)
 

Parish of Death

District of Death

How Did the Person Die? (Indicate appropriately)    

Date of Registration
- dd-mm-yyyy format

Registration Number

Place of Registration (Parish)

Place of Registration (District)

Applicant’s First Name

Applicant’s Middle Name

Applicant’s Last Name

Applicant’s Address (Street)

Applicant’s Address (Line 2)

Applicant’s Address (Town)

Applicant’s Address (Parish) - If In Jamaica

Applicant's Country

Additional address information required for applicants living outside of Jamaica
Applicant's City Applicant's State Applicant's Postcode Zip

Applicant's Relationship to Deceased

Your email address

Telephone Numbers
(Home)
(Work)
(Cell)

Any Special Instructions.

Pickup location information required for applicants living in Jamaica

                

   

Reason for applying

IF VALID DATA WAS NOT ENTERED IN THE MANDATORY FIELDS THIS APPLICATION CANNOT BE PROCESSED


     


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