Katoomba
150 Bathurst Road
Ph: (02) 4782 2922 • Fax: (02) 4782 4624
Springwood
5 Raymond Road
Ph: (02) 4751 6166 • Fax: (02) 4751 1800
My Funeral Wishes

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My funeral has been Pre-arranged/Pre-Paid with Blue Mountains Funerals
First Name:
 Surname:
Email:

Phone:
Address:

Date Of Birth:

Place Of Birth:

Religion:

Preferred Clergy or Celebrant:

Telephone:

At:

Preferred Service Location:

Parent's Details

Father's Full Name:

Mother's Full Name:

Mother's Maiden Name:

Location of Will:

Marriage Details

Current Marital Status:

First Marriage:
Age at Marriage:
 Place of Marriage:
Date of Marriage:
 Name of Spouse:

Second Marriage:
Age at Marriage:
 Place of Marriage:
Date of Marriage:
 Name of Spouse:

Children

Give first names, current surnames, gender and date of birth of all children including any legally adopted, still born or deceased. If more than 4 children, please attach details

1
Given Names:

Surname

Male FemaleDate of Birth:

2
Given Names:

Surname

Male FemaleDate of Birth:

3
Given Names:

Surname

Male FemaleDate of Birth:

4
Given Names:

Surname

Male FemaleDate of Birth:

Funeral Preference:
Burial
Cemetary Plot No.:
Cremation
Ashes to be placed:

I would like the following people to carry my coffin/casket:

I would like the following people to speak at my service:

I would like the following hymns or songs played:

I would like the following prayers or poems to be read:

I would prefer the following flowers for my coffin:

I prefer mourners to give donations to the following charities:

I would like the following people and organisations to be notified:

Special Instructions:

Remember, if you are pre-paying or pre-arranging your service, please inform your executor and/or family.