Deceased Companion Animal Form

Deceased Animal Notification Form

Please complete to advise of a deceased companion animal so that the NSW Register can be updated

Title* - required

First name* - required

Surname* - required

Contact number* - required

Email address* - required

Are you the owner of the animal?* - required

Yes No

Is the owner's mailing address the same as the address above?* - required

Yes No

Animal Details

Type of animal* - required

Cat Dog

Sex* - required

Male Female

Microchip Number

Animal's name* - required

Breed* - required

Colour* - required

I advise that the animal detailed above died on (or approximately)* - required

I declare that the information provided is true and correct. I understand there are heavy penalties for providing misleading information* - required

Option to attach copy or photo of death certificate

Mandatory field(s) marked with *

Last Edited: 27 Mar 2019

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