Pre-Planning Application Form

Loved One's Details

First Name *

Middle Name(s)

Surname *

Also known as (surname)

Optional — use if your loved one has another legal surname, for example from a previous marriage.

Gender *

Aboriginal?

Date of Birth Unknown / To be confirmed

Usual occupation during working life

Age

Calculated where possible; can be corrected manually.

Place of birth

Suburb / Town

State

Country

Expected place of death and usual residence

Expected place of death (optional)

Hospital Nursing Home Home Other

Usual residence

Other information

Has your loved one made any written instructions about their cremation or funeral arrangements?

Are you aware of anyone who may object to the planned cremation?

Does your loved one have a pacemaker or any implanted electrical devices?

Family details

Marriages

What is your loved one’s current marital status?

Children

Does your loved one have any children?

Parents of loved one

Parent one

Relationship / type

Given Names

Surname

Maiden surname (if applicable)

Usual occupation

Parent two

Relationship / type

Given Names

Surname

Usual occupation

Applicant / informant

Given Names *

Surname *

Mobile *

Email *

Relationship to loved one *

On Form 6, the applicant is applying as

Applicant address *

Certification

I confirm that the information I have provided is accurate to the best of my knowledge. I understand that these pre-planning details may need to be reviewed and updated when cremation arrangements are made.

Signature *

The signing date and time will be recorded with the submission.