FUNERAL ARRANGEMENT FORM

Please Read Before Filling In This Form

The information you provide us in this form is used to supply you with the official Death Certificate from Qld Births, Deaths and Marriages Office (BDM). The information needs to be filled out fully and correctly to enable us to complete the paperwork without delay ensuring you receive the Death Certificate within 3-4 weeks of funeral.

If the information is incorrect and a change to the Death Certificate is required a further cost of $19.95 payable to BDM may be required.

    Details of person completing the Pre-arrangement form

    Address

    Deceased Person's Details

    Normal Address
    (Town/City, State and Country)

    Current Marital / Civil Partnership Details

    Parent's Details

    Children's Details

    Funeral Wishes

    [radio* radio-151 use_label_element default:1 "Civil Partnership " "Civil Partnership Terminated Defacto " "Divorced " "Married " "Never Married" "Registered Relationship " "Widowed" "Unknown"]
    [radio* radio-901 use_label_element default:1 "At Cemetery / Crematorium only" "At Church with procession to Cemetery / Crematorium" "No service required" "Another venue (nominate specifics below)"]

    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.
    Terms and Conditions I acknowledge that I have read and understand the Terms and Conditions and confirm that the information provided is to the best of my knowledge and belief, true, accurate and not misleading.

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