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Pre Arrangement Form

Please use the form below to provide us with information and instructions.

You can download the PDF form by clicking the Download Form link below.

You can return the completed form to

1 Cameron Place, Orange NSW

or Fax: 02 6360 2999

Alternatively use the Web form below to submit your request.

Pre Arrangement Web Form

Your Contact Details
Your Name
First Last
Phone Number
Please provide your phone number.
Email Address

Please supply your best contact email address if available.
Arrangement Details
Please fill out the details for the person who's arrangements are being made for.
Surname*
Given Names
Surname at Birth
Gender
- Male
- Female
Next of Kin Details
Next of Kin Phone Number
Next of Kin Address
Solicitor
Usual Occupation during working life
Place of Birth
Date of Birth
If born Overseas - year of arrival in Australia
Pension Details
Are you of Aboriginal or Torres Straight Islander Origin
- Yes
- No
Marital Status
- Never Married
- Married
- De Facto
- Separated
- Widow/er
Place of Marriage
Age at Marriage
Full name of Spouse including surname at Birth
No. of Children
(Add Name/Date of Birth & Sex for each child)
Father's Full Name
Mother's Full Name including Maiden name
Would you prefer
- BURIAL
- CREMATION
Internment Where
Any special instructions
CAPTCHA

Phone: 02 6360 1199

1 Cameron Place Orange NSW 2800