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

Applicant Details

Title*

MrMrsMsDr

Surname*

First Name(s)*

Postal Address*

Postcode*

Email Address

Home Phone Number*

Work Phone Number*

Mobile Phone Number*

Full name*

Date*

Certificate

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

Death Certificate*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

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