Datum:
To Whom It May Concern,Department of Home Affairs
SUBJECT: AUTHORIZATION LETTER FOR DEATH REGISTRATION
I, , with ID Number , hereby authorize , with ID Number , to act on my behalf to register the death of at the Home Affairs Office.
I am unable to attend the registration in person for the following reason:
I confirm that the above-mentioned person has my full permission to handle all necessary procedures and documentation relating to this matter on my behalf.
Yours faithfully
Full Names: Signature:Date: Contact Number:
Dear Sir/Madam
RE: DECEASED
Full Names of Deceased: ID Number:
This letter serves to confirm that I, , ID Number , Residential Address , being the relationship to the deceased , have instructed and mandated Strydom Funeral Home to attend to the registration of death with the Department of Home Affairs.
We kindly request that you assist the nominated staff member of Strydom Funeral Home who will sign as the informant on our behalf in order to register the death of the deceased.
Yours faithfullyFull Name and Surname: Signature:Date: Contact Number:
Kliënt verifikasie handtekening:
STRYDOM FUNERAL HOME
I, , in respect of the late , hereby confirm the truth, accuracy and completeness of all information supplied to Strydom Funeral Home. I certify that I am the duly authorised person to instruct Strydom Funeral Home to attend to all matters as requested. I acknowledge liability for all funeral-related costs as reflected on the Pro Forma Invoice.
CLIENT DECLARATIONName of Deceased: Client / Executor Name: ID Number: Relationship to Deceased: Residential Address: Contact Number: Email Address:
FORM A - APPLICATION FOR CREMATIONAll questions to be answered. Do not leave blank spaces.
I do hereby solemnly and sincerely declare that all the particulars stated above are true and that, to the best of my knowledge and belief, no material particulars have been omitted.
Signature of applicant:Date:
FORM B - MEDICAL CERTIFICATECertificate of Medical Attendance
Nota: Slegs die oorledene se besonderhede word hier ingevul. Die mediese vrae bly oop vir die dokter om te voltooi.
Doctor signature: ______________________________ Registered Qualifications: ______________________________
Name: ______________________________ Date: ______________________________
Address: ______________________________ Tel no: ______________________________