Direct Funerals Online Arrangement Form

First name

Last name

Please enter your preferred contact number

Email

Kindly confirm you will act as the client and assume responsibility for overseeing the funeral arrangements

I am the client

I'm acting on behalf of the client

Not Applicable - Statement of Intent

Has the Death been registered?

Yes

No

Not Applicable - Statement of Intent

Name and Address of Deceased

Date of Birth and Date of Death

Burial or Cremation

Burial or Cremationtb

Burial

Cremation