TO WHOM IT MAY CONCERN

I wish to notify you of the death of:

Mr/Mrs/Miss/Ms

Surname........................................................................................................................
Given name....................................................................................................................
Date of Birth..............................................

of

Street name & number....................................................................................................

Suburb.............................................................................................................................

State................................... Postcode............................

on

Date of death...............................................

I understand the above had dealings with your organisation

The reference number/membership for your organisation was.......................

Please amend your records. If you need to contact me for further information, my phone number is................................................................

Signature................................................................

Name & Address......................................................

...............................................................................

Relationship to deceased .........................................

Date.........................................................................

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