Enquiry Form

To arrange a funeral, pre-arrange a funeral plan or apply for funeral bonds, please fill out the form below and click on the submit button. One of our staff will contact you as soon as possible in relation to your enquiry.
 
This enquiry is in relation to:
As the person making this enquiry, please provide your contact details below.
My full name is:
My email address:
My phone number is:
My mobile number is:
My postal address
Please fill out the personal details of the person this enquiry is in relation to eg The deceased or the nominee of the funeral plan
Full Name:
Age (as at December 31 this year):
Date of Birth (Day, Month, Year):
Residence
Birthplace
Years in Australia
Occupation
Marital Status
Mother's Names
Mother's Maiden Name
Mother's Occupation
Mother's Spouse 1
Name of Spouse:
Where Married:
Mothers's Married Name:
If spouse is deceased, place and date of death.
Mother's Spouse 2
Name of Spouse:
Where & When Married:
Mother's Married Name:
If spouse is deceased, place and date of death.
Mother's Spouse 3
Name of Spouse:
Where & When Married:
Mother's Married Name:
If spouse is deceased, place and date of death.
Father's Names
Father's Occupation
Marriage Details. Please provide details for all marriages.
Father's Spouse 1
Name of Spouse:
Where & When Married:
Wife's Maiden Name:
If spouse is deceased, place and date of death.
Father's Spouse 2
Name of Spouse:
Where & When Married:
Wife's Maiden Name:
If spouse is deceased, place and date of death.
Father's Spouse 3
Name of Spouse:
Where & When Married:
Wife's Maiden Name:
If spouse is deceased, place and date of death.
Children's Names and birth dates (living)
Children's Names and birth dates (deceased)
Do you wish for a burial or cremation? Please select one
Burial
Cremation
Please indicate your religion
How did you hear about us?
Advertisement - Publication?
Internet
Word of Mouth
Other. Provide details below:
Please indicate if the person is/ was in reciept of a pension.
DVA
Centrelink
Questions or Comments: