Electoral Services Notify of Resident Death

Please be aware that it is an offence to knowingly provide false information to an Electoral Registration Officer which can result in a prison sentence and an unlimited fine.
Fields marked with * are required
Deceased Details
1. Full name of deceased resident*
2. Date of Birth (DD/MM/YYYY)
  Please provide their date of birth if known
3. Are you able to upload a copy of the death certificate*
  
  Yes
  
  No
4. Please post a photocopy of the death certificate to our Dereham office:
  
  Electoral Services Team,
  
  Breckland Council,
  
  Elizabeth House,
  
  Walpole Loke,
  
  Dereham
  
  Norfolk, NR19 1EE
5. Proof of Death Documentation
  Documents accepted: Death Certificate. Permitted file type: JPEG, PNG, PDF. Maximum file size: 5MB
7. Please enter the resident's postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
  
  If their address is not shown please enter the address manually.
8. Their Postcode:
10. Address Box
11. First line of their address:*
12. Address 2:
13. Town:*
14. Postcode:*
Was the resident registered to vote at this address?*
1. Yes
2. No
3. Don't Know
Previous Address Details
1. Please provide details of their previous address where you think they are registered to vote.
2. Please enter the resident's previous postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
  
  If their address is not shown please enter the address manually.
3. Their Postcode:
5. Address Box
6. First line of their address:
7. Address 2:
8. Town:
9. Postcode:
Your details
1. Your Full Name:*
2. Do you have an email?*
  
  Yes
  
  No
3. Your Email:
4. Your Telephone Number:*
5. Please enter your postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
  
  If your address is not shown please enter the address manually and use the map to pinpoint it.
6. Your Postcode:
8. Address Box
9. First line of your address:*
10. Address 2:
11. Town:*
12. Postcode:*
13. Are you completing this form on behalf of someone else?:*
  
  Yes
  
  No
14. Assisted service details
  1. In what capacity are you completing this form?:
    
    CC Staff
    
    Agent/Solicitor
    
    Relative/Friend
    
    Carer
    
    Other
  2. Name of person completing this online form:
  3. Email of person completing this form:
15. I confirm that as the person providing this information, I understand that it is an offence to knowingly provide false information to an Electoral Registration Officer and that it can result in a prison sentence and an unlimited fine*
Privacy statement

Breckland Council is collecting this information, via this form, in order to perform this service or function, and if further information is needed in order to do so, you may be contacted using the details provided.

In performing this service, the Council may share your information with other organisations or departments, but only when it is satisfied that it is necessary to perform a public task, or to exercise its statutory duties to do so.

The Council may also share your personal information for the purposes of the prevention, investigation, detection, or prosecution of criminal offences, but will not share your personal information, or use it for any other purpose, unless provided for by law.

More detailed information about the Council's handling of your personal data can be found in our privacy policy.
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Electoral Services Notify of Resident Death

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Electoral Services Notify of Resident Death

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