Online Pre-Arrangement Form

Person completing the form

Email

Please contact me Yes No

Funeral Arrangements for

Contact Phone No

Funeral Service

It is my desire that my Funeral Service should be held at:
(Chapel, Church, Cemetery, Crematorium or other venue)

Venue Name

Address Please include Town, State and Country.

Existing burial arrangements

I have an allotment at (cemetery)

Grave Details

or new burial arrangements

Please arrange a burial at (cemetery)

or cremation details

I wish to be cremated at

And that my ashes be

Newspaper Notice placed in

Donation envelopes Please choose No Yes

Charity Name

Flowers for the coffin/casket

Type of arrangement

Information required by law

My given names are

My Surname is

My date of birth is

Sex Please choose Male Female

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? Please choose No Yes

If so which type? Please choose Nil Old Age Military Invalid

My parents information

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

My marital information

My present marital status Single Married De Facto Divorced Widow Widower Separated

If Widowed please state

Date of death of Spouse

Place of death of Spouse

First marriage

Spouse's given names

Spouse's surname

I was married at Please include 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 include 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 include place of marriage, town, state and country.

My age when married, years

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):

First child

Second child

Third child

Child four

Child five

Child six

Child seven

Child eight

Other details

I would like the following persons notified of my passing

First person

Second person

Third person

My documents

My will is lodged with

My Solicitor is

I have a funeral benefit plan with

I have a Life Insurance policy with

Anything else?

Specific Requests

or