dieses Formular in deutsch este formulario en español ce formulaire en français

Death Certificate
Order Form

Questions, you don't know the answer: just let the field empty. But please bear in mind: Any information more you can deliver increases the chance to get the document you need.

Place of Death
(Town, Canton/Bundesland/Département):
Staat:
(other countries: Please ask me previously by e-mail)
Death Address (Hospital, Street etc.)
Date of Death (Day, Month, Year):
Family Name of the deceased person:
First Name(s) of the deceased person::
Sex of the deceased person:
Nationality:of the deceased person:
(Swiss Citizens:: Place/s of origin):
Place of Birth of the deceased person:
Date of Birth of the deceased person:
Father of the deceased (Name, First Name/s):
Mother of the deceased (Name, First Name/s):
Civil Status of the deceased person:
(last) spouse (Name, First Name/s):
The right to purchase a death certificate is
limited by the law. Therefore I kindly ask you to
state your relationship with the deceased person
and the reasons, why you need this document:
By my signature I am authorising Mr. Renato Caccia to procure the above mentioned death certificate.
Mit meiner Unterschrift beauftrage ich Herrn Renato Caccia mit der Beschaffung der obigen Sterbeurkunde.
Par ma signature, j'autorise M. Renato Caccia à se procurer l'acte de décès susmentionné.
Con la presente autorizzo Sig. Renato Caccia a procurarsi l'Atto di Morte succitato.
Date: Signature: __________________________________

If you need the Death Certificate in view of an administrative proceeding, please answer to the following questions:

What's the name of the authority which is
asking you for this death certificate?
Address (if available)
or residence place of this
authority (City and Country):


Additional needs:

Death Certificate on plurilingual international form

Consular Legalization or Apostille for the following country:

Translation of the Death Certificate into the following language:

furthermore a notarial legalization of the translation

furthermore a consular Legalization or Apostille for the translation


The Death Certificate should be sent to the following address:

Name und First Name / Company:
Postal address (street and n° or P.O. Box)
Postal Code, Town and Country:
Your fax n°
Your phone n°
Your e-mail address


Fees (payable in advance):
If you feel uncertain about your needs or about the fees in your particular case, ask for an estimate by e-mail

I enclose the following amount in cash
I'll pay the fees by credit card.
My Card number is: its expiry date is (Month/Year) /
I'll pay the fees online by credit card. Please inform me how to do it.
I paid already the amount of online by credit card.
I paid the amount of by "Western Union".
The "Money Transfer Control Number" MTCN is as follows:
I enclose a bank or personal check

Please fill in this form, print it out, sign it and send it by post or fax to:
Renato Caccia, Wehntalerstr. 115, 8057 Zurich, Switzerland
Fax from Switzerland: 044 361 70 16; Fax from other countries: +4144 361 70 16
or scan the signed order form and send it by e-mail: renaca@bluemail.ch

home