Skip to content
24 Hour Service 7 Days A Week -
07 3252 2031
-
info@kmsmith.com.au
-
Home
Notices & Tributes
Upcoming Services
Tributes
History Of Excellence
Our Services – Est. 1883
Our Family History
Funeral Options
When Someone Dies
Funeral Options
Our Products
Our Kate Mary Chapel
Preplan
News & Events
K.M.Smith News
Presentations
Your Connection With K.M.Smith
Tracing Your Family History
Employment Opportunities
Our Therapy Dog
Contact
Contact
Locations
Loading...
Request A Quote
Request A Quote
Request A Quote
admin
2019-07-15T16:34:28+10:00
Please fill in the form below and one of our representatives will be in contact shortly.
Please enable JavaScript in your browser to complete this form.
1
2
3
4
5
6
Deceased Personal Details
Full Name
*
Date of Birth
*
Place of Birth
*
Address
*
Date of Death
Place of Death
Occupation
Year Arrived In Australi
Aboriginal / Islander
No
Yes
Pension Number
Veterans Affairs Number
Medicare Number
Regular Doctor's Name
Next
Deceased Parents
Father's Full Name
Father's Occupation
Mother's Full Name
Mother's Maiden Name
Mother's Occupation
Previous
Next
Decased's Marriages
Marital Status
Never Married
Married
Widow(er)
Divorced
Previous
Next
Decased's Children
First Child
Christian Names
Date of Birth
Second Child
Christian Names
Date of Birth
Third Child
Christian Names
Date of Birth
Fourth Child
Christian Names
Date of Birth
Fifth Child
Christian Names
Date of Birth
Sixth Child
Christian Names
Date of Birth
Seventh Child
Christian Names
Date of Birth
Eighth Child
Christian Names
Date of Birth
Ninth Child
Christian Names
Date of Birth
Tenth Child
Christian Names
Date of Birth
Previous
Next
Service Details
Service Type
Burial
Cremation
Preferred Cemetery / Crematorium
I wish the cremated remains to be
Religion
If church service, preferred Church
Do you want flowers on the coffin?
Yes
No
Further instructions or requests
Previous
Next
Contacts
Next Of Kin / Executor
Name
Address
Person Completing This Form
Name
Address
Preferred Contact Person
Name
Relationship To Deceased
Other
Date
Telephone Number
*
Email Address
*
Additional Comments
Previous
Name
Submit
