Alex Gow Funerals - Online Pre-Arrangement

The following information has been recorded by me in the hope that, at the time of my passing, it will make it easier for my family to make the decisions needed to organize and carry out a funeral with Alex Gow Funerals as per my wishes.

Please ensure you have completed the * required fields before you press the send button.

Email:	*
Please Contact me:	YesNo
Funeral Arrangements for:	*
Contact Phone No:	*
It is my desire that my Funeral Service should leave from
Name and address of Chapel, Church, Cemetery, Crematorium or other venue:
I have an allotment at this cemetery:
Grave Details:
I have no ground but would request a burial in this cemetery:
or
I wish to be cremated at this Crematorium:
And that my ashes be:

Newspaper Notice placed in:
Donation envelopes displayed at the service:	YesNo
Charity Name:
Type of floral arrangement for the coffin/casket

INFORMATION REQUIRED BY LAW
My given names are:
My Surname is:
My date of birth is:
Sex:	MaleFemale
My Current Address is:
My Phone Number:
My Usual Occupation:
I was born at:	Please include Town of Birth, State and Country.

Do you receive a pension?	YesNo
If so which type?

If Widowed please state
Date of death of Spouse:
Place of death of Spouse:

INFORMATION REGARDING MY PARENTS IS AS FOLLOWS:
My Fathers given names:
My Fathers surname:
My Fathers occupation is/was:

My Mothers given names:
My Mothers maiden name was:
My Mothers occupation is/was
INFORMATION REGARDING MARRIAGE IS AS FOLLOWS:
First Marriage
Spouse's given names:
Spouse's surname:
I was married at:	please included place of marriage, town, state and country.
My age when married, years:

Second Marriage
Spouse's given names:
Spouse's surname:
I was married at:	please included place of marriage, town, state and country.
My age when married, years:
Third Marriage
Spouse's given names:
Spouse's surname:
I was married at:	please included place of marriage, town, state and country.
My age when married, years:

My present marital status:

MY CHILDRENS INFORMATION
The names and ages of my children are as follows. (Please place a 'D' in the age field if your child is deceased):
1. Name:
Age:
2. Name:
Age:
3. Name:
Age:
4. Name:
Age:
5. Name:
Age:
6. Name:
Age:
7. Name:
Age:
8. Name:
Age:
OTHER DETAILS
My will is lodged with:
My Solicitor is:

I would like the following persons notified of my passing
1. Name:
Phone Number:
2. Name:
Phone Number:
3. Name:
Phone Number

I have a funeral benefit plan with:
I have a Life Insurance policy with:
Specific Requests: