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Death Notification Form 3/14

The Births and Deaths Registration Act of 1992 requires that a medical doctor - or a registered nurse in the case of a stillbirth - complete a Death Notification Form for all decedents in South Africa. Form DHA-1663 is issued in books of 20 death notification forms. The form consists of 4 pages. 

Page 1 contains information on how the decedent was identified by the certifying doctor. This is to prevent life insurance fraud.  It also contains details of the decedent, such as name, surname, date of birth, date of death, ID number, sex and residential address.  Other socio-demographic variables - such as level of education, occupation and smoking status – are also entered. 

Page 2 requires information on the certifying medical practitioner or forensic pathologist, including the HPCSA registration number.  On this page the doctor needs to state whether they are in a position to confirm that the person died due to natural causes.  If you are not able to state this with certainty the form should NOT be completed, and the case should be referred to the Forensic Pathology Services. 

The last page is the medical certificate of cause of death. This section is confidential and should be sealed by the doctor after completing the form.