Use the form below to apply for an early pregnancy loss commemorative certificate.
Once completed, email your form to firstname.lastname@example.org (External link). Attach a document (e.g. utility bill, bank statement) that shows your current residential address.
For more information, see early pregnancy loss commemorative certificate.
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Department of Justice and Community Safety
Registry of Births, Deaths and Marriages Victoria, State of Victoria, 2020
Date of Publication
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