Funeral Arrangement Form

Step 1 of 9

11%

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

Details of person completing the Arrangement Form

Authorised Person's Name (name of person completing this form)(Required)

Relationship To Deceased(Required)

Your Email Address(Required)

Your Mobile Phone Number

Your Home or Work Phone Number

Address

Street Address Address Line 2 City State Post Code Country

Deceased Person's Details

First Names(Required)

Surname(Required)

Date of Death(Required)

DD slash MM slash YYYY

dd/mm/yyyy

Place of Death(Required)

Eg. name of hospital or institutuion, address of private residence

Sex(Required)

Male

Female

Date of Birth(Required)

DD slash MM slash YYYY

dd/mm/yyyy

Normal Address(Required)

Street Address Address Line 2 City State Post Code Country

Usual Occupation When Working

Retired(Required)

Yes

Place of Birth(Required)

(Town/City, State and 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)

Aboriginal

Torres Strait Islander

Aboriginal and Torres Strait Islander

Is there a pacemaker or defibrillator present?(Required)

Yes

Current Marital / Civil Partnership Details

Marital Status:

Civil Partnership

Civil Partnership Terminated

Defacto

Divorced

Married

Never Married

Registered Relationship

Widowed

Unknown

Number of Marriages / Civil Partnerships:

Place of most recent union:

Deceased's Age In Years At Date of Marriage / Civil Partnership:

First Name of Spouse or Civil Partner

Surname of Spouse or Civil Partner at Time of Union

Was the deceased person previously married or joined in civil union(s)

Yes

Details

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

Children

Number of children born to the subject person.(Required)

If more than 10 children please contact our office.

Child 1's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 2's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 3's Given Names

Date of Birth

MM slash DD slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 4's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 5's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 6's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 7's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 8's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 9's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

Child 10's Given Names

Date of Birth

DD slash MM slash YYYY

dd/mm/yyyy

Deceased

Child is deceased

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

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

Yes

Authorisation

Authorised Person(Required)

I, the Authorised Person noted above, hereby certify that I am legally entitled to give the above instructions and indemnify Premier Funerals Group from any legal proceedings resulting from my not being the person legally entitled to give the above instructions.

(Required)

I agree

Payment

I agree to pay Premier Funeral Group a deposit of 50% prior to the day of service.

(Required)

I agree

THE PAYMENT CAN ONLY BE MADE BY CREDIT CARD BY CALLING 3375 1455 OR ELECTRONIC TRANSFER TO OUR BANK ACCOUNT - WESTPAC ACCOUNT BSB 032-044 ACCOUNT NUMBER 743056 AND NOT BY MAIL OR IN PERSON.

Please Assist Us

How did you find us?

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

Premier Funerals Sunshine Coast

Please Read Before Filling In The Form