Information Required For Registration of a Death

Surname

Given Names

Date of Birth

Gender

Male
Female

Address

Email Address

Phone Number

Occupation

Place of Birth

Years in Australia

Are you of Aboriginal origin?

Yes
No

Are you of Torres Straight Islander origin?

Yes
No

Marital Status

Married
Never married
Widow/er
Separated
Divorced
De facto

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 & dates of birth

Mother's surname

Mother's maiden family name

Mother's given names

Mother's usual occupation during working life

Father's surname

Father's given names

Father's usual occupation during working life

About My Funeral

My chosen Funeral Director is (include name/address/telephone number)

I wish my funeral to be held at

I wish to be buried at

I have a reserved grave at (include grave number or location 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/telephone number)

My funeral is pre-arranged/pre-paid with (name & address of Funeral Director)

My Pre-paid Funeral Plan number is

Other wishes/ details

Personal Information

(this will be helpful at the time)

My Will is located at

My Solicitor is (include name/address/telephone number)

My Pension number is

My Bank/Credit Union/Building Society accounts are located at

I have a safe deposit box at

My Doctor is (include name/address/telephone number)

Other items which may be important or relevant

Submit your information to Wimmera Funerals by email. (You will also be emailed the information for your records)