Application for death certificate
*Applicant`s name and adress:
Name:
Adress:
Postcode:
Tel:
E-mail adress:
* Number of certificates or copies required:
Certificate
Copy:
*Details of death:
Surname and forenames at death:
Date of death (specify year):
Place of death:
Additional information:
Details of death record (if known):
Year:
Book:
Page:
Record number:
Name and delivery adress (name, adress and postcode of the person to whom you neeed the document to be sent – is very important that a postcode is provided):
Name:
Adress:
Postcode:
Payment details:
Send a cheque/ postal order expressed in euros made payable to ARQUIVO REGIONAL DA MADEIRA. If you would rather pay by money transfer, place the sumi n the following account: (IBAN: PT50 0019 0045 0020 0002 51094; bankcode SWIFT BBVAPTPL). Please advise of the transfer by mail or letter. The required document(s) will be sent only after confirmation that the payment has been duly credited.
* required fields
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ENGLISH VERSION 
