PRE PLANNING – YOUR INFORMATION Step 1 of 4 25% I would prefer:*CremationBurialMy Name is: First Middle Last I was born at:Date Date Format: DD dash MM dash YYYY 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: Date Format: DD dash MM dash YYYY in this town/city:To:Full Name of SpouseMaiden Name:Is your spouse deceased:YesNoPlace of death:Date of Death: Date Format: DD dash MM dash YYYY Do You Have Any Children?YesNoChild 1's Full NameChild 1's Date Of Birth Date Format: MM slash DD slash YYYY Child 2's Full NameChild 2's Date Of Birth Date Format: MM slash DD slash YYYY Child 3's Full NameChild 3's Date Of Birth Date Format: MM slash DD slash YYYY Child 4's Full NameChild 4's Date Of Birth Date Format: MM slash DD slash YYYY Child 5's Full NameChild 5's Date Of Birth Date Format: MM slash DD slash YYYY Child 6's Full NameChild 6's Date Of Birth Date Format: MM slash DD slash YYYY Child 7's Full NameChild 7's Date Of Birth Date Format: MM slash DD slash YYYY 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: Date Format: MM slash DD slash YYYY 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 Date Format: DD dash MM dash YYYY 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 EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
