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(03) 5470 5951

info@mafunerals.com.au

12 Campbell Street, Castlemaine

195 High Street, Kangaroo Flat (Bendigo)

Online Pre-Arranged Funeral Service

 

This form has been prepared in two sections, Section A covers Personal Details, and Section B covers your Funeral Requests.

 

    Section A: My Personal Details

    Title *

    Given Names *

    Surname *

    Address *

    Phone Number *

    Email Address *

    Place of Birth *

    Date of Birth *

     

     

    Occupation (If retired former occupation) *

    Marital Status *
    MarriedWidowedDivorcedNever Married

    Name of Spouse (including maiden name)

    Place of Marriage

    Date of Marriage

    Previous marriage (if any)WidowedDivorcedSeparated

    Name of Spouse (including maiden name)

    Place of Marriage

    Date of Marriage

    Childrens' Details

    1st Child

    MaleFemale

    Name

    Date of Birth

    2nd Child

    MaleFemale

    Name

    Date of Birth

    3rd Child

    MaleFemale

    Name

    Date of Birth

    4th Child

    MaleFemale

    Name

    Date of Birth

    5th Child

    MaleFemale

    Name

    Date of Birth

    6th Child

    MaleFemale

    Name

    Date of Birth

    Your Parents Details

    Father's full name

    Father’s occupation

    Mother’s full name

    Mother’s maiden name

    Mother’s occupation

    Next of Kin Details

    Next of Kin *

    Full Name of Next of Kin

    Phone

    Address

    Executor

    Full Name of Executor

    Phone

    Address

    Doctor

    Full name of Doctor

    Phone

    Address

    Section B: Your Funeral Preferences

    I would like *
    a burial service (Please nominate cemetery and grave number if pre-purchased)a cremation service (please nominate crematorium)

     

    Wishes for ashes UrnPlacementCrematorium siteScattering

     

    I would like my service at *
    my churcha funeral chapelanother locationwith a full funeral procession to cemetery / crematoriumwithout a funeral procession

     

    I would like the service conducted by *
    a minister of religiona civil celebrantanother person

     

    My coffin / casket choice is

     

    In regards to a viewing *
    I would like to have an open coffin forFamily onlyI do not want an open coffin or viewing

     

    The songs I would like played at my services are

    pre-recordedLive e.g. Bagpiper…, Organist, Musician, Bugler (Last Post, Reveille, etc)

     

    I would like a flag draped over my coffin
    AustralianRAAFNavy (White Ensign)Union JackOther

     

    In regards to flowers at the service…

    I would like the following varieties

    I would prefer people did not send flowers and request they instead make a donation to the charity shown below.

     

    I would like to be dressed in *
    a favourite outfitclub outfit/uniformnight wearother

     

    I would like my death / funeral notices to appear in the following newspapers.

     

    In regard to immediate family support I would like
    cars to be providedthem to use their own vehicles

     

    I would like to have pallbearers at the service

     

    Specific items I would like at the service
    MedalsTrophiesMusic instrumentsFavourite photosSporting itemOthers

    I would like a special DVD presentation of my life shown at the service
    YesNo

     

    I would like a Standard Order of service produced for hand-out at the service
    YesNo

     

    I would like a Memorial Book supplied as a family keepsake
    YesNo

     

    My Wake / After-Service Celebrations

     

    I would prefer my family and friends celebrate my life with *
    a catered gathering at the chapela function at a family member's homea catered function at a club or similarI would prefer there was no after-service activityothers

     

    Other Requests

     

    As a member of the following Clubs/Associations I would specially like them notified of my service

     

    Important

     

     

    Would you like to discuss a pre-paid funeral with us? YesNo TICK here and a representative will contact you personally within 2 working days.