Pre Arrange Your Funeral

Please fill out the required Details below. If you feel that you do not wish to give us certain personal details over the internet, please leave in written in the box, 'Will contact' or visit us in person at 123 Mostyn St, Castlemaine 3450

Personal and Family details

Your Given Names*

Your surname*

Maiden Name (if Applicable)

Date of Birth (DD/MM/YYYY)*

Place Of Birth (Town,State, Country)

Email Address

Pension No. (if Applicable)

Medicare No.

Nationality (if other than Australia)

Marriage Details

My field

Married Widow(er) Divorced Never Married Separated

Place of Marriage (Town,State,Country)

Date of Marriage (DD/MM/YYYY)

Wife/Husbands Full Name

If you have been previously married, Please give details of any previous marriges

Occupation Before Retirement or Current Employment

Occupation Before Retirement or Current Employment

Children

Please enter full names,date of birth and

Child 1

Child 2

Child 3

Child 4

Other Childen

Parents Details

Fathers Full Name

His Occupation

Mothers Full Name

Her Maiden Name

Her Occupation

Next of Kin

Full Name of Next of Kin

Address of Next of Kin

Phone Number/s

Location of Will

Solicitors name and Address

Executors Name and Address

Details of any Pre-Arrangements or Pre payments:

Name and Address of funeral Director:

Location of your copy of those arrangements

Funeral Details

Service to be held at:

and

Clergy/Celebrant:

Denomination

Cemetery(Burial) / Crematorium(Cremation)

Grave/Memorial Details

Clubs to be Notified

Other Wishes to Attend to

Other Wishes to Attend to

Your Contact Details

BH Phone Number

AH Phone Number

Postage Address

Would you like to Recieve an information pack?

Mail (post)

Would you like to find out more information about the following by post

Pre - Paid Funerals
Funeral Insurance
Funeral Travel Insurance

We Suggest you print this form now as you cannot come back to it.

please do not send fake forms, as we keep track of who they come from, and can be tracked