Funeral Director

Funeral Directors *

Please select. If 'Other' is selected please give company name, address and telephone number in Notes box below.)

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Telephone Number *

Please give the number applicable to this funeral

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Main Contact for this Funeral *

Please give name of person managing the deceased's funeral

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Email *

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Notes

Any additional; information

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Funeral For

Title *

Please choose a title

Name *

First name *

Please enter a First name

Middle name(s)

Surname *

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Known as *

Please give the name by which the deceased was usually known

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Date Of Birth *

Please enter a valid date

Date of Death *

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Age at Death *

Age in Years

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Late of *

Home address of the deceased at the date of death

Address 1 *

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Address 2

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Address 3

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Town *

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County *

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Postcode *

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Country *

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Place and Cause of Death *

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Service Requested

Proposed Date *

We will advise whether it is possible to hold the service on the date and at the time requested

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Proposed Time *

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Type of Service *

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Which Church is to be used? *

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Optional extras

Organist

Live Stream of Service (Holy Trinity only)

Please select at least one of the options

Which Crematorium, Cemetery or Burial Ground is to be used? *

If 'Other' please give fill details (including site name and postcode) in box below

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Additional Information

Please include any special requests (such as a particular minister)

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Next of Kin

Relationship to Deceased *

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Title

Please choose a title

Name *

First name *

Please enter a First name

Middle name(s)

Surname *

Please enter Surname

Address *

Address 1 *

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Address 2

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Address 3

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Town *

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County *

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Postcode *

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Country *

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Home Phone

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Mobile *

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Email *

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Contact Consent *

Please answer 'Yes' to confirm the Parish has permission to make direct contact with this person

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Contact for Organising the Service (if not Next of Kin)

Is someone other than the Next of Kin Organising the Service?

Yes - please give their contact details below

No - the Next of Kin is responsible

Title

Please choose a title

Name

First name

Please enter a First name

Middle name(s)

Surname

Please enter Surname

Address

Address 1

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Address 2

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Address 3

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Town

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County

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Postcode

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Country

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Home Phone

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Mobile

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Please enter a valid email

Contact Consent

Please answer 'Yes' to confirm the Parish has permission to make direct contact with this person

Please select an option

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