Recognition of early pregnancy loss certificate application

Use this form to commemorate an early pregnancy loss with a certificate including parent’s names, baby’s name and the location and date of the loss.

Eligible parents can order a certificate free of charge to commemorate an early pregnancy loss.

Please note this is a commemorative certificate, not an official legal document.

Before you download

Before you complete the recognition of early pregnancy loss certificate application, make sure you are eligible to apply. 

After you fill out the form

When you have completed the application, submit according to the instructions on the application form.

Resource downloads

Recognition of early pregnancy loss application form PDF 83.82KB File last updated on: 02 September 2026.

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Related links

Type: Form
Author: NSW Registry of Births, Deaths and Marriages
Publication Date: 01 July 2025

Tagged in

Family and relationships
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