Funeral Pre-arrangement Form

All answers are important. If you are unsure or do not know the correct details, please indicate appropriately.

Details of person completing the Pre-arrangement form

Full Name(Required)

Relationship To Subject Person(Required)

Your Email Address(Required)

Your Mobile Phone Number

Your Home or Work Phone Number

Address(Required)

Street Address Address Line 2 City State Post Code Country

Subject Person's Details

Full Name(Required)

Sex

Male

Female

Date of Birth(Required)

dd/mm/yyyy

Normal Address

Street Address Address Line 2 City State Post Code Country

Usual Occupation When Working

Retired(Required)

Yes

No

Place of Birth(Required)

(Town/City, State & Country)

If born overseas, in what year did the subject person first arrive in Australia?

Is the subject of Aboriginal or Torres Strait origin(Required)

No

Aboriginal

Torres Strait Islander

Aboriginal and Torres Strait Islander

Parent's Details

Father's First Names(Required)

Father's Surname(Required)

Father's Occupation

Mother's First Names(Required)

Mother's Maiden Surname(Required)

Mother's Occupation

Funeral Wishes

Funeral Type(Required)

Burial

Cremation

Venue of Funeral(Required)

At Cemetery / Crematorium only

At Church with procession to Cemetery / Crematorium

No service required

Another venue (nominate specifics below)

Which Crematorium?

Service By

Church official

Our celebrant

Religion / Denomination (if any)

Other Requirements

Will a Newspaper Notice be required/(Required)

Yes

No

Will the Flag and/or Last Post be required?(Required)

Yes

No

Please Assist Us

How did you find us?

Eg. a referral from family or friend, Google search etc

Please Read Before Filling In The Form