Funeral Arrangement Form

All answers are important. If you are unsure or do not know the correct details, please indicate appropriately.

Details of person completing the Arrangement form

Type N/A if none

Deceased Person's details

dd/mm/yyyy
eg Name of hospital or institution, address of private residence
dd/mm/yyyy

Current Marital/Civil Partnership Details

If widowed, divorced or in a de facto relationship, answer No.

Town/City and State or Country (if overseas)
Place of union, Age at time, Partner's first names, Partner's surname (at time of event)

Parents' Details


Children

dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy

If more than 10 children, please contact our office.


Funeral Wishes

dd/mm/yyyy

Other requirements


Authorisation

I, the Authorised Person noted above, hereby certify that I am legally entitled to give the above instructions and indemnify Michael Hutchinson Funeral Director from any legal proceedings resulting from my not being the person legally entitled to give the above instructions.


Payment

I agree to pay Michael Hutchinson Funeral Director the agreed full payment at least 24 hours before the funeral occurs only by credit card or electronic transfer.

THE PAYMENT CAN ONLY BE MADE BY CREDIT CARD BY CALLING 3273 1399 OR ELECTRONIC TRANSFER TO OUR BANK ACCOUNT -
WESTPAC ACCOUNT BSB 032-044 ACCOUNT NUMBER 772711
AND NOT BY MAIL OR IN PERSON.
PLEASE BE AWARE THAT WE DO NOT BILL SOLICITORS, TRUST OFFICES OR ANY OTHER THIRD PARTIES.


Please assist us