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Early pregnancy loss recognition certificate

We offer our condolences for your loss.

To recognise your loss, you can apply for a free recognition certificate—there are 2 designs for you to choose from. You cannot use the certificate for official purposes.

If your delivery took place after 20 weeks, you will need to register the birth.

How to apply

We are not able to register the birth but you do have the right to commemorate your family’s loss—if your baby was delivered before 20 weeks gestation or if weeks are unknown, weighed less than 400g.

It can take up to 15 minutes to complete this application form.

1. Answer the questions below.
2. Review your details.
3. Print your completed application form.
4. Get your treating medical practitioner or midwife to sign the declaration on the application form.
5. Submit your signed application form in person or by post.

1. Can I commemorate our family's early pregnancy loss?

   1. Did your loss take place in Queensland? *

      • Yes
      • No
   2. Did your loss take place before 20 weeks—or, if weeks are unknown, your baby weighed less than 400g? * (If you chose 'Yes' above)

      • Yes
      • No
   3. Is your treating medical practitioner or midwife available to sign the declaration? * (If you chose 'Yes' above)

      • Yes
      • No
   4. By using this online service and providing an email address and mobile number, I consent to the use of that email address and mobile number for BDM to contact me via SMS and email that relates to this application. I understand that it is my responsibility to ensure that I have nominated a secure email address for BDM to send any related correspondence to. I acknowledge that it is my responsibility to ensure the security of that information upon receipt of it.
2. Fill in your application Fill in the application and get it signed before submitting it.

   1. The design I would like *

      • Flower
        
      • Candles
        
   Baby's details
   If you choose not to provide a name the certificate will show—Baby of mother's name and father's/parent's name.
   1. Baby's name

      1. First name
      2. Middle name/s
      3. Family name
   2. We understand that due to the circumstances of your pregnancy loss you may not be able to give the following details.
   3. Place

      1. Town/city
      2. State *
   4. Date dd/mm/yyyy
   5. Gestation in weeks
   6. Weight of baby
   2. Mother's details

      1. Mother's name

         1. First name *
         2. Middle name/s
         3. Family name *
      2. Age * In years
   3. Father's or parent's details

      Parent details are provided for same sex parents and your choice determines how your relationship is shown on your child's recognition certificate.

      1. I am the baby's

         • Father
         • Parent
      1. Father's or parent's name

         1. First name
         2. Middle name/s
         3. Family name
      2. Age In years
   4. Who is applying

      1. Relationship to baby *

         • Mother
         • Father
         • Parent
      2. Your postal address

         1. Address line 1 *
         2. Address line 2
         3. Address line 3
         4. 1. Town, city or suburb *
            2. State *
            3. Postcode *
      3. Telephone number * Daytime number
      4. Mobile number *
      5. Email *
   5. Before I complete my application *

      • I will check the details I have provided.

   Remember

   You will need to submit your application signed by you and your health care professional to use by post or in person to finalise your order.

We cannot commemorate a loss outside of Queensland.

See a list of interstate and overseas registry offices.

Please complete a birth registration application.

We cannot issue you with a recognition certificate if the declaration has not been signed.

How to submit

By post

Post your completed application form to:

Registry of Births, Deaths and Marriages
PO Box 15188
CITY EAST QLD 4002

In person

Visit the Brisbane registry customer service centre at Level 32, 180 Ann Street, Brisbane with your completed application form.

Contact us

Email bdm-mail@justice.qld.gov.au, we reply to online enquiries within 2 business days.

Local call* 13 QGOV (13 74 68)
International +61 7 3022 0001 (+10 hours UTC)

(Phone lines open Monday–Friday, 8.30am–4.30pm)

*Costs may be higher from mobile phones and interstate.