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Pre-Paid Cremation & Prearranged Cremations
Information Required to Register for a Pre-Paid/Prearranged Cremation
Part 1 - Applicant Details
1. Full, correct name of the applicant?
*
2. Email
*
3. Phone number
*
4. Date and place of birth
*
5. If born overseas, how long did he/she live in Australia?
6. Usual residential address
*
7. Usual occupation
*
8. Is he/she retired?
*
9. Is he/she receiving a pension?
*
10. Is he/she of Aboriginal or Torres strait origin?
*
Aboriginal
Torres Strait
Both
Neither
Part 2 - Next of Kin
11. Name
*
12. Next of kin email
*
13. Next of kin phone number
*
14. Relationship to applicant
*
15. Address
*
Part 3 - Applicant's Relationships
16. Does the applicant have a partner?
Yes
No
Married
In a Domestic Relationship
Widowed
Divorced
Single
Unknown
17. If married, please list all marriages of the applicant (Starting with the most recent)
Marriage 1
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Place of Marriage Suburb/Town
State
Country
Date of marriage
Marriage 2
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Place of Marriage Suburb/Town
State
Country
Date of marriage
Marriage 3
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Place of Marriage Suburb/Town
State
Country
Date of marriage
18. If domestic relationship, please list all relationships of the applicant
Domestic Relationship 1
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Is the relationship registered?
Yes
No
Place of Registration - State\Territory
Country of registration
Year of Registration
Domestic Relationship 2
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Is the relationship registered?
Yes
No
Place of Registration - State\Territory
Country of registration
Year of Registration
Domestic Relationship 3
Partner's given name(s)
Partner's sex
Male
Female
Partner's Family name
Is the relationship registered?
Yes
No
Place of Registration - State\Territory
Country of registration
Year of Registration
Part 4 - Applicant's Children
19. Does the applicant have any children?
Yes
No
If YES, please specify each child's details.
Child given name(Full Name)
Date Of Birth
Part 5 - Parents of the Applicant
20. Mother/Parent's surname (family name)
21. Mother/Parent's given name(s)
22. Mother/Parent's surname at birth
23. Occupation of the Mother\Parent during working life
24. Mother/Parent's Date of birth
25. Father/Parent's surname (family name)
26. Father/Parent's given name(s)
27. Father/Parent's surname at birth
28. Occupation of the Father\Parent during working life
29. Father/Parent's Date of birth
