Pre-Planning A Funeral

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 4670

My religious affiliation is:

My private doctor is:

My Preferences
Funeral Home ChapelGravesideOther

I would like to have officiating:
Minister of religionCelebrant from funeral homeNon-denominational ChaplainOther

Casket type
Solid WoodParticleboardMetal

Flowers 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 SectionOther

Or This Cemetery
Bundy CatholicGin GinChildersOther

If 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 service
YesNo

A headstone has / has not been arranged with:

My funeral has been pre-paid in part in full with

as trustees of this date

Details can be located at

Military: (e.g. R..S.L., Legacy, T.P.I.)

Particulars of my affiliation with aforementioned military organisations are:
ArmyNavyAir ForceOther

Service 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:

I have a Will located at:

My Solicitor is:

Their Phone is:

My Executor/s:

Their Phone is:

Your Email*

Your Phone

Street Address

City

State / Province / Region

ZIP / Postal Code