Horsham & District Funerals

Online Personal Record

The only required information is in the first section (required fields are marked with a *), any other info may be left out at your discretion.

This form will be printed out by Horsham & District Funerals and stored for later use. After submitting the form, you will be able to download or print it as you require.

Personal & Family Details

* Surname:
* Given Names:
* Date of Birth:
* Address:
* Sex:
* Email address:
* Occupation:
* Place of Birth:
Years in Australia if born overseas:
* Marital Status:
Place of Marriage:
Age when Married:
Name of spouse prior to marriage:
If more than one marriage, please supply the same details for each marriage:
Given names of children and dates of birth:
Mothers full name:
Mothers maiden name:
Mothers occupation:
Fathers full name:
Fathers occupation:

Funeral Details


My Funeral Director is (name/phone/address):
I wish my funeral to be held at (eg. denomination of church/private chapel):
I wish to be buried at:
I have a reserved grave at (include grave number if known):

or

I wish to be cremated at:
I wish my ashes to be placed at:

My next of kin/executor is (include name/address/phone):
My funeral is pre-arranged/pre-paid with (include name/address/phone of Funeral Director):
My pre-arranged/pre-paid funeral number is:
Other wishes/details:

Helpful Details

My will is located at:
My solicitor is (include name/address/phone):
My pension number is:
Other details which may be important or relevant: