Apply for a stillbirth document from outside Alberta

You can apply for the following stillbirth documents:

• Certified Copy of Registration of Stillbirth
• Certified Copy of Medical Certificate of Stillbirth

When you complete the application form you will choose the type of document that you are requesting.

Registry Connect Co-op can only process applications for clients who are not in Alberta.

If you are living in Alberta, please contact your nearest registry office .

Eligibility requirements for stillbirth documents are found on page 2 of the application form.

Historical records must be applied for through the Provincial Archives of Alberta . Anyone may apply for a historical record. The following historical stillbirth records are available:

• copies of Registrations of Stillbirth 75 years old and older (from the date of stillbirth)
• copies of Medical Certificates of Stillbirth 75 years old and older (from the date of stillbirth)

To complete your application you will need to download and complete the following forms:

• Application for Stillbirth Documents (DVS11166S Rev. 2020-02)
• Statutory Declaration for Proof of Identity (DVS3512)
• Registry Connect Co-op Payment Page (2024-11)

If you are unable to open the PDF documents, right-click and save the document, and then open it in Adobe Reader .

We can also email, mail, or fax a copy to you. Please contact us for more information.

Pages 1 and 2 of the document contains important information that will help you complete your application. Please read these pages carefully.

Page 3 of the document - Application for Stillbirth Documents - contains the following sections to complete:

• Eligible Applicant's Information - this section needs to be completed in full. The address you provide here will be the address where we send your certificate unless you instruct us otherwise.
• Alternate Mailing Address - only fill out this section if you would like us to send your certificate to an address other than the one you provided above.
• Type of Document - enter the quantity of each different document that you require.
• Stillbirth Details - this section needs to be completed in full. Only the provinces or countries of birth of the parents is required, we do not need the city of birth of your parents.
• When filling in the parents’ information for the birth certificate, please provide the mother’s maiden name (last name at birth).

If you have valid (not expired), government-issued photo identification continue to completing the Statutory Declaration for Proof of Identity

If you do not have valid government-issued photo identification you will need a to appoint a Designated Agent to become the Applicant on your behalf. Your Designated Agent can be anyone, as long as they have their own valid government-issued photo identification, and as long as you have known them for at least 1 year. Complete the Applicant's Consent to Designated Agent and Designated Agent's Statutory Declaration sections. The Designated Agent must then complete the Statutory Declaration for Proof of Identity to verify their own identification.

All Applicants must complete the Statutory Declaration for Proof of Identity to verify their valid photo identification. To do this, the page must be taken to a Notary or Commissioner for Oaths, who must look at your identification, and then complete questions 1 through 7. Then the Notary/Commissioner must sign the form and provide their name and the expiry date of their commission. The Applicant must also sign the form.

Any changes made to your Statutory Declaration (crossed or whited out information, or information added later in a different colour pen) must be initialled by the Notary or Commissioner of Oaths who notarized your form. Changes that have not been initialled, or have been initialled by someone other than the Notary or Commissioner of Oaths, will result in a returned Statutory Declaration.

Select your service

Select the service option that works best for you:

•  Gold Service

  These rush requests receive top priority. We will contact you by phone or email if there are questions or concerns with the application forms. Requests are submitted to Vital Statistics, who will contact you if there are any discrepancies between your application and the original record. Once printed, documents come back to our office and are then sent out by Purolator Courier. Delivery is secure and trackable.

  Cost: 40.00 CAD per document, plus a 35.00 CAD rush processing service fee, plus the courier's delivery fee.

  Courier fees vary according to the destination - please calculate your payment on the order form.

•  Silver Service

  This service also offers priority processing. We will contact you by phone or email if there are questions or concerns with your application. Requests are submitted to Vital Statistics, who will contact you if there are any discrepancies between your application and the original record. Once printed, certificates are sent out by regular mail via Canada Post, and are not trackable.

  Cost: 40.00 CAD per document, plus a 35.00 CAD rush processing service fee.

•  Bronze Service

  We process applications in the order in which they are received in our office. We will contact you by email or letter about any issues with your application. Vital Statistics will communicate with you by letter regarding any discrepancies between what is on the application and what is on the original record. Documents are sent out by regular mail via Canada Post, and are not trackable.

  Cost: 40.00 CAD per document (no other fees will apply).

For more information about our processing times and delivery policy, please see our terms of service.

Provide your email

Provide us with an email address so that we can contact you if necessary.

Make your payment and provide your transaction number

We accept payments online by credit card.

Please make your payment online - we accept Visa, Visa Debit, Mastercard, Debit Mastercard, and Discover.

Once your payment has completed, you will receive a transaction number - please write this number on your Payment Page. You will also receive a receipt by email to keep for your records.

We also accept payment by certified cheque (a cheque that has been guaranteed by your bank, it is not a regular personal cheque) or money order in Canadian or US funds. Certified cheques or money orders are to be made out to Registry Connect Co-op, and must be drawn on a Canadian or US bank.

All fees are payable up front - there are no COD deliveries for certificates. Once an application has been processed, fees are usually non-refundable. For more information please see our refund policy.

To complete your application, you must still mail or courier your application form to us.

We only accept applications sent by mail or courier to the following address:

Registry Connect Co-op
Suite 207, 236 91 Street SW
Edmonton, AB  T6X 1W8
Canada

We recommend sending your forms using a trackable mailing method such as a courier. Please do not fax or email a copy of your application to us. We are unable to accept applications this way.