Funeral Arrangement Form

You can arrange a funeral by completing the form below and then clicking the Send button.

Most of the questions we ask on this form are a legal requirement for death registration, but some others are optional.

If you don’t have all the information we ask for at the present time, you should complete what you can and we’ll work with you to complete the remainder.

The five minimum items of information we’re required to collect are marked with a asterisk *.

Deceased Personal Details

Full Name (Required)

Date of Birth (Required)

Place of Birth (Required)

Address (Required)

Date of Death

Place of Death

Occupation

Year Arrived in Australia

Aboriginal / Islander

NoYes

Pension Number

Veterans Affairs Number

Medicare Number

Regular Doctor's Name

Deceased Parents

Father's Full Name

Father's Occupation

Mother's Full Name

Mother's Maiden Name

Mother's Occupation

Deceased's Marriages

Marital Status
Never MarriedMarriedWidow(er)Divorced

First Marriage

Where Married

At What Age

To Whom

Spouse Deceased

Place of Death

Date of Death

Second Marriage (If Applicable)

Where Married

At What Age

To Whom

Spouse Deceased

Place of Death

Date of Death

Third Marriage (If Applicable)

Where Married

At What Age

To Whom

Spouse Deceased

Place of Death

Date of Death

Fourth Marriage (If Applicable)

Where Married

At What Age

To Whom

Spouse Deceased

Place of Death

Date of Death

Fifth Marriage (If Applicable)

Where Married

At What Age

To Whom

Spouse Deceased

Place of Death

Date of Death

Deceased's Children

First Child

Christian Names

Date of Birth

Second Child

Christian Names

Date of Birth

Third Child

Christian Names

Date of Birth

Fourth Child

Christian Names

Date of Birth

Fifth Child

Christian Names

Date of Birth

Sixth Child

Christian Names

Date of Birth

Seventh Child

Christian Names

Date of Birth

Eighth Child

Christian Names

Date of Birth

Ninth Child

Christian Names

Date of Birth

Tenth Child

Christian Names

Date of Birth

Service Details

Service Type

BurialCremation

Preferred Cemetery / Crematorium

I wish the cremated remains to be

Religion

If church service, preferred Church

Do you want flowers on the coffin?

YesNo

Further instructions or requests

Contacts

Next Of Kin / Executor

Name

Address

Person Completing This Form

Name

Address

Preferred Contact Person

Name

Relationship To Deceased

Other

Date

Telephone Number (Required)

Email Address (Required)

Additional Comments