| Surname / Family Name |
: |
| First / Given Names |
: |
| Surname at birth (if different than surname at death) |
: |
| First Names at birth (if different than names at death) |
: |
| Birth date |
: |
| Birth Place |
: |
| Usual Residential Address |
: |
| If not born in New Zealand, what year did the person arrive in NZ? |
: |
| The person's usual occupation |
: |
| Was the person decended from a New Zealand Maori? |
: Yes / No / Don't know |
| Full name of Mother |
: |
| Full name of Mother at her birth |
: |
| Mother's Occupation |
: |
| Full Name of Father |
: |
| Full Name of Father at his birth |
: |
| Father's Occupation |
: |
| Latest Type of Relationship |
: Civil Union / Marriage / de facto |
| The person's age at the time of the solemnisation of the union (Civil Union or Marriage), or entered a defacto relationship |
: |
| The place of solemnisation of the union (Civil Union or Marriage) |
: |
| Partner or Spouse's Full Name at that time |
: |
| The sex and age of the partner or spouse of the person (if still living when the person died) |
: |
| |
| Previous Type of Relationship |
: Civil Union / Marriage / de facto |
| The person's age at the time of the solemnisation of the union (Civil Union or Marriage), or entered a defacto relationship |
: |
| The place of solemnisation of the union (Civil Union or Marriage) |
: |
| Partner or Spouse's Full Name at that time |
: |
| The sex and age of the partner or spouse of the person (if still living when the person died) |
: |
| |
| Previous Type of Relationship |
: Civil Union / Marriage / de facto |
| The person's age at the time of the solemnisation of the union (Civil Union or Marriage), or entered a defacto relationship |
: |
| The place of solemnisation of the union (Civil Union or Marriage) |
: |
| Partner or Spouse's Full Name at that time |
: |
| The sex and age of the partner or spouse of the person (if still living when the person died) |
: |