APPLICATION FOR A DEATH CERTIFICATE
PLEASE READ THESE NOTES before completing this form.
Death Certificate
: STR/11/58
1 TO BE COMPLETED BY THE APPLICANT
Name of applicant Mr
Mrs
Miss/Ms
(STATE NAME IN FULL)
Full postal address
 
Post Code: Telephone no: e-mail address:
2 Please state your relationship to the person to whom the certificate relates:
 
3 DETAILS OF DEATH CERTIFICATE REQUIRED
SURNAME OF DECEASED   DATE OF DEATH
PLACE OF DEATH (Full address or name of hospital)
FORENAME(S)
OCCUPATION  DATE OF BIRTH or AGE AT DEATH
HOME ADDRESS  If a married woman, please give name and surname of husband 
4 REQUIREMENTS Send this Application to:
DEATH CERTIFICATE £10.00 Superintendent Registrar, Trafford Register Office, Town Hall, Sale Waterside, Sale, Cheshire, M33 7ZF, UK
I requireNUMBER death certificate(s)
5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)
UK: applications should enclose an SAE. Postal order or cheque made payable to : Trafford Borough Council for £ 10.00
Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Bankers Sterling Draft payable to : Trafford Borough Council
If paying by Credit Card: Please debit my account by the amount: £ Type of card
(e.g. Visa, Mastercard or Switch):
Name on Card:
 
Card Expiry Date (DD/MON/YYYY):
Enter both Card Number & Security Code. Card Number:                                       Security
Code:
     
Signature:
 
Date:

 

Card Issue No. :
(Switch only)
Card Start Date (DD/MON/YYYY):
(Switch only)
The Fee for a certificate issued against this form 'as printed' will not be refunded.
You are strongly recommended to add any qualifying information you may have in order to help the registrar issue the correct certificate.