Registration of Intent

Please complete the details below for the person whose burial is being considered. If a burial is required immediately, please contact us by telephone.

(*) Asterisk indicates required information

Title (Mr. Mrs. Ms. etc.) Invalid Input First Name(*) Invalid Input Last Name(*) Invalid Input
Date of Birth(*)
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Address 1(*) Invalid Input Address 2 Invalid Input
Suburb/Town/City(*)Invalid Input State(*) Invalid Input Post Code(*) Invalid Input
(*)
Please provide primary contact number.

Area Code(*) Invalid Input Preferred Contact Number(*)Invalid Input Area CodeInvalid Input Second Contact NumberInvalid Input
Email(*) Invalid Input Re-Enter Email(*) Invalid Input
Please provide details for an alternative Contact

Title (Mr. Mrs. Ms, etc.) Invalid Input First Name Invalid Input Last Name Invalid Input
Address 1 Invalid Input Address 2 Invalid Input
City/Town/Suburb Invalid Input State Invalid Input Post Code Invalid Input
Area Code Invalid Input Preferred Contact Number Invalid Input Area Code Invalid Input Alternative Contact Number Invalid Input
Email Invalid Input Confirm Email Invalid Input

If you are unable to complete this form, please call us on 1300 466 860 and we will assist you.

How did you hear about us?
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Any Comments?
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What attracts you to this service?
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Any Comments?
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Would you like assistance in organising a burial pre-payment?
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Best contact number
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