Funeral Details (Fill In All relevant Information)

Please have all relevant documents on hand before filling out this form, Eg ID card

Service & Burial

Graveside Service & Burial

Service & Cremation

Cremation & Burial Of Ashes

Cremation (Alone)

Quantity

Full Name (Including Middle Name) *

Nick Name (AKA) *

National Id Card Number *

Address *

Date Of Birth *

Date Of Death *

Place Of Death

Optional

Age *

Sex *

Male

Female

Marital Status *

Married

Devorced

Widow

Widower

Single

Name Of Church (For Funeral service)

Optional

Name Of Cemetary (For Interment)

Optional

Prefered Date For funeral

Optional

Prefered Time For Funeral

Optional

Person Registering Death. (Name) *

Address *

Cell Phone Number (WhatsApp)

Optional

Home Phone Number or 2nd Cell Number

Optional

National ID Number *

Relationship To deceased *

Husband

Wife

Child

Other Family Member

Friend

Other

If Other Please State

Optional

Is the above person responsible for payment?

Optional

Yes

No

If NO please provide payers name

Optional

Payers Address

Optional

Payers Tel Number

Optional