APPLICATION FOR A DEATH CERTIFICATE
Isle of Wight Council iow logo

APPLICATION FOR A DEATH CERTIFICATE

ISLE OF WIGHT REGISTER OFFICE,  Registrars Services, Seaclose Offices, Fairlee Road, Newport
Isle of Wight, PO30 2QS
(01983 821000)(email [email protected])

IMPORTANT
Please read the Customer Information which contains the terms and conditions

padlock APPLICANT
Title  
Forename
Middle name/Initials
Surname
APPLICANT ADDRESS DETAILS
(We will contact you only if we have difficulty finding your requested entry)
Building/house name/number
Street address
Town Name

County
Country
Postcode
Home Tel Number

(include area code)


Mobile Tel Number
Email address

FULL DETAILS OF THE CERTIFICATE YOU REQUIRE
Surname of the person who has died

other spellings of surname
Forename(s) at death

Date of death

             year          month            day

Place of death(town if known)
Home address











Date of birth

or

age at death:
         year            month          day



         years old
If married or widowed, full name and surname of husband








COST
Please note that there will be a fixed postal cost of £1.00 added to each application submitted
, or, please include a stamped addressed envelope
Standard Certificate £10.00 No. of certificates required



METHODS OF PAYMENT
Cheques, postal orders should be made payable to �IWC�. Do not send Cash. Please enclose a stamped addressed envelope with applications. The Isle of Wight Register Office aim to return applications within two working days. If we have a problem with your application we will always try to ring you in the first instance.


APPLICANT TO COMPLETE

I enclose a cheque/postal order made payable to �IWC� to the value of �����


��������������������.(signature of applicant)
Data Protection Act 1998
padlock

This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request.

The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest.

Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law.
Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box




To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box





ProductCostVAT codeGL Code
Registration Service postage£1.00AE25000723001
Death Certificate (Standard)£10.00AN25000732201

Date printed: 07/03/2013