Your Name (required)

Your Email (required)

Please leave this field empty.

CHECKLIST
Who else needs to be informed? There are a number of people and organisations that will need to be notified about a death. This checklist provides a helpful guide to assist your family and friends.

FAMILYDEATH CERTIFICATE APPLICATIONDOCTORSOLICITORFUNERAL DIRECTORAUSTRALIAN TAXATION OFFICEMEMORIALISATIONTELEPHONE COMPANIESEXECUTOR OF WILLPUBLIC TRUSTEECENTRELINKMEDICAREBANKS & OTHER FINANCIAL INSTITUTIONSELECTORAL ROLLACCOUNTANTLOCAL AUTHORITIES / COUNCILLANDLORDHEALTH FUNDSHOMECARE NURSINGCLUBS & ORGANISATIONSMEALS ON WHEELSPUBLIC SERVICES SUCH AS LIBRARIESINSURERSDENTISTHIRE PURCHASE COMPANIESPOST OFFICECHURCHLIFE INSURANCESUPERANNUATION FUNDPAID TV/INTERNET PROVIDERSEMPLOYERS / EMPLOYEESDEPARTMENT OF VETERANS AFFAIRS

FUNERAL SERVICES PROVIDED BY (choose one)

Heritage Brothers, Burleigh HeadsEaston Funeral Services, Tweed HeadsHeritage Brothers, Chinderah

FUNERAL DETAILS

MY FUNERAL SERVICE VENUE

BURIAL OR CREMATION
BurialCremation

LOCATION OF CREMATORIUM OR CEMETERY

DETAILS

CELEBRANT/CLERGY

PUBLIC OR PRIVATE SERVICE Public Private
PublicPrivate

FUNERAL SERVICE NOTIFICATION

PREFERRED NEWSPAPERS FOR NOTICES

ONLINE NOTIFICATIONS

CLUBS/GROUPS THAT SHOULD BE NOTIFIED

MY COFFIN SELECTION (see our coffin selection here - opens in new window)

MY CHOICE OF CLOTHING TO BE DRESSED IN

ITEMS / FLOWERS TO BE PLACED IN MY COFFIN

MY SERVICE MUSIC

MY FAVOURITE READINGS/POEMS

RSL INVOLVEMENT

Sub Branch:

RSL Tribute (Last Post Poppy Service) YesNo

Flag Requirements

FOR GUESTS AT YOUR SERVICE

CATERING REQUIREMENTS

RECORDING OF SERVICE
YesNo

ORDER OF SERVICE BOOKLETS
YesNo

PAYMENT PLAN

PREPAID FUNERAL PLAN

PREPAID FUNERAL PLAN DETAILS

MEMORIALISATION REQUEST

MY WISHES FOR MY CREMATED REMAINS

ADDITIONAL INFORMATION

MY PERSONAL PROFILE

MY FAMILY NAME (required)

MY GIVEN NAMES (required)

GENDER
MaleFemale

PLACE OF BIRTH

DATE OF BIRTH

RELIGION (IF APPLICABLE)

OCCUPATION IN WORKING LIFE

USUAL ADDRESS including suburb and postcode

USUAL DOCTOR’S NAME

DOCTOR'S PHONE NUMBER

DATE OF ARRIVAL IN AUSTRALIA if applicable

PENSION
YesNo

Pension Type

Pension Number

ARE YOU OF ABORIGINAL OR TORRES STRAIT ISLAND ORIGIN?
YesNo

NEXT OF KIN
Name

THEIR USUAL ADDRESS including suburb and postcode

PHONE NUMBER

EMAIL

ALTERNATE NEXT OF KIN
Name

THEIR USUAL ADDRESS including suburb and postcode

PHONE NUMBER

EMAIL

ADDITIONAL INFORMATION

MY MARITAL STATUS (PLEASE TICK APPROPRIATE BOX)
MarriedDefactoSeparatedDivorcedNever MarriedWidow/Widower

If widowed, date and place of death of spouse:

MY FIRST MARRIAGE

PLACE OF MARRIAGE

DATE OF MARRIAGE

NAME OF SPOUSE

MY SECOND MARRIAGE

PLACE OF MARRIAGE

DATE OF MARRIAGE

NAME OF SPOUSE

MY CHILDREN
Please give Name, Date of Birth and Gender for each.

MY PARENTS DETAILS

Father’s full name

Father’s occupation

Mother’s full name

Mother’s maiden name

Mother’s Occupation

VITAL INFORMATION FOR YOUR EXECUTORS

Location Of Will

MY SOLICITOR
Name

Address (please include Suburb & Postcode

Phone/Mobile

MY EXECUTOR

Address (please include Suburb & Postcode

Phone/Mobile

SPECIAL NOTES
Use this area to add any extra information you feel may be useful such as additional personal details (academic, sporting or community achievements or awards, for instance), other persons who should be informed, or log-in details of online accounts that may need to be closed such as email or social networking websites.