Online Form - Application for Placing Ashes

Details of Deceased

Surname *

First Name(s) *

Last place of residence of deceased *

Postcode *

Date when death occurred *

Place where death occurred *

Birthplace of deceased *

Denomination *

Plot No *

Date and Time of placing ashes *

Fees Applicable: $126.50 (Inc GST)

Payment Method *

Cash
Cheque
EFTPOS - Credit Card (Visa or Master)
Debit Card

Title *

MrMrsMsDr

Surname *

First Name(s) *

Postal Address *

Postcode *

Email Address

Home Phone Number *

Work Phone Number *

Mobile Phone Number *

Full name *

Date *

Please attach a copy of the Death Certificate with this form.

Death Certificate *

Maximum size of ALL attachments is 976.56 MB

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