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Application To Hold a Funeral

Burial Details

Cemetery*

Religion*

Section*

Roman Catholic
Other Denomination
Muslim

Plot No*

Date of Funeral*

Time of Funeral*

Other Details*

Details About Deceased

Surname*

First Name(s)*

Last Residential Address*

Postcode*

Personal Details*

Male
Female

Birth Place of Deceased*

Date of Birth*

Date of Death*

Age of Deceased*

Place of Death*

Applicant Details

Title*

MrMrsMsDr

Surname*

First Name(s)*

Postal Address*

Postcode*

Relationship to Deceased*

Email Address*

Home Phone Number*

Work Phone Number*

Mobile Phone Number*

Full name of applicant*

Date*

Funeral Director Details

Title*

MrMrsMsDr

Surname*

First Name(s)*

Name of Funeral Home*

Postal Address*

Postcode*

Email Address

Home Phone Number

Work Phone Number

Mobile Phone Number

Nam of Minister to Officiate at grave*

Full name*

Date*

Dinemsions

Width of Coffin*

Length of Coffin*

Depth of Grave*

Size of Ground*

Backfill*

CouncilFamily

Please attach a copy of Death Certificate or Coroner’s Report when lodging this form*

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