PRE PLANNING – YOUR INFORMATION Step 1 of 4 25% I would prefer:*CremationBurialMy Name is: First Middle Last I was born at:Date My father’s name is:Whose occupation was:My mother’s name is:Whose occupation was:Maiden Name:Whose occupation was:I currently live at:1123 Bourbong St, East Bundaberg 4670In my working life, my main occupation / profession is / was:My marital status is: Single Married Widow/ed Divorced Partnership I was married on this date: in this town/city:To:Full Name of SpouseMaiden Name:Is your spouse deceased:YesNoPlace of death:Date of Death: Do You Have Any Children?YesNoChild 1's Full NameChild 1's Date Of Birth Child 2's Full NameChild 2's Date Of Birth Child 3's Full NameChild 3's Date Of Birth Child 4's Full NameChild 4's Date Of Birth Child 5's Full NameChild 5's Date Of Birth Child 6's Full NameChild 6's Date Of Birth Child 7's Full NameChild 7's Date Of Birth My religious affiliation is:My private doctor is:Whose practice is at: My Funeral arrangements for Burial My PreferencesFor the service to take place at:Funeral Home ChapelGravesideI would like to have officiating:Minister of religionCelebrant from funeral homeNon-denominational ChaplainCasket typeSolid WoodParticleboardMetalFlowers Are Welcome? Yes, Flowers Are Welcome I would prefer donations instead of flowers to:I would like my passing to be recorded in the following newspapers:I prefer to be interred at;Bundaberg General CemeteryLawnGin Gin / ChildersMonumentalVault SectionOr This CemeteryBundy CatholicGin GinChildersIf the family plot already exists, the grave details are:I am to be buried with (namely):Who died on: and who is my:My favourite song / hymn is:Refreshments and fellowship may be arranged after the serviceYesNoA headstone has / has not been arranged with:My funeral has been pre-paid in part in full withas trustees of this date Details can be located at Memberships I belong to the following organisations:Military: (e.g. R..S.L., Legacy, T.P.I.)Particulars of my affiliation with aforementioned military organisations are:ArmyNavyAir ForceService No:Served with (e.g. Battalion):At:Other Relevant Information:Service Clubs: (e.g. Rotary, Lions, Apex)Sports/Social Clubs: (e.g. Bowls, Cycling, Cricket, Gym)Other Groups: (e.g. Church, Charity, Hobby, Lodge)Centrelink Pension No:Veteran Affairs Pension No: Estate Information I have a Will located at:My Solicitor is:Their Phone is:My Executor/s:Their Phone is:Contact Information Your Email* Your PhoneYour Address Street Address City State / Province / Region ZIP / Postal Code PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
