ADULT Application & Consent Form

This application form gives permission to MFS to perform the Funeral of the deceased with the consent of the Next of Kin or Authorised representative.

This form MUST be completed before the MFS can proceed with any arrangements.

ALL of the information of the deceased, including correct spelling of names, dates, details of the family, marriages and children is COMPULSORY.

This information is required by the Registry of Births, Deaths & Marriages to register the death and issue the Death Certificate. Correct information is essential.

The official DEATH CERTIFICATE will be issued by the Registry of Births, Deaths & Marriages according to the information provided by you here.

To avoid delays and inconvenience PLEASE provide the correct information, and exactly how it appears on the deceased's official records and as it should appear on the Death Certificate.

The name must match the Cause of Death issued by the Doctor. If this is incorrect, please get the Doctor to amend the details.

Incorrect information which requires resubmission or issuing an amended Death Certificate will incur additional fees and cause undue delays.

For any non-applicable information (eg. deceased is not married or has no children) please insert N/A on the form or if completed prior to expected death - for dates can insert 00 00 0000 in date.

Insert any additional information in the comments section.

Deceased's Full Name*

PrefixFirst NameMiddle NameLast Name

Residential Address*

Street number

Street name

SuburbState

Post CodeCountry

Phone Number Primary NOK Contact*

Date of Birth*

DayMonthYear

Date of Death

DayMonthYear

Age at death*

Years / Months / Days

Gender*

MaleFemale

Place of Death*

Street Address

Street Address Line 2

SuburbState

Post CodeCountry

Name of Hospital or Nursing Home if death occurred there:

Name of Contact person @ Hospital or Nursing Home

Telephone Number of Hospital Contact

Name of Deceased's usual Doctor*

Telephone Number of Doctor*

Usual Occupation of deceased during working life*

Was deceased retired?*

YesNo

Place of birth (City, town and Country)*

If born overseas, what year did deceased arrive in Australia

Was deceased of Aboriginal or Torres Strait Islander Origin*

NOYes AboriginalYes TSIBoth

Marital Status at time of death*

List ALL marriages of deceased starting with most recent. If not married please insert N/A*

	Place of marriage (City, Country)	Deceased's age at the time of marriage	First Name of Spouse	Last name of spouse (at time of marriage)
1.
2.
3.
4.

Parents details*

	First name	Surname	Occupation during working life
Father's details
Mother's details

List FIRST name of all the children of the deceased from eldest to youngest. If child deceased insert "D". If stillborn "SB". If no children write none. Include legally adopted children.

	FIRST NAME	Date of birth	Age
1
2
3
4
5
6
7
8
9
10

Full Name NOK*

First NameMiddle NameLast Name

Address of NOK*

Street Address

Street Address Line 2

SuburbState

Postal CodeCountry

Relationship to deceased*

Phone Number NOK*

Phone

Mobile Number NOK*

Mobile

E-mail NOK*

Email NOK

Ghusl Venue:*

Is there a pre-purchased grave for the deceased? Please provide details if so.

Name of Cemetery

Plot number

This is to confirm that I am the authorized next of kin or representative of the deceased, and/or I act with the full authority of the family of the deceased*

YES

I confirm that the Deceased is Muslim, and to the best of my knowledge the deceased believed that there is only one God (Allah) and that the Prophet Muhammed (SAW) is the final prophet of Allah SWT.*

YES

I also confirm that I am liable to pay all fees and charges due for the funeral. These fees have been explained to me.*

Yes

I also understand that MFS Ltd & BMBS Inc will not be held responsible for any error or omission beyond their control.*

Yes

I do NOT hold MFS Ltd or its Directors, employees or volunteers responsible for an injury (either physical or psychological) sustained by myself or any person nominated by me, whilst observing any Islamic customs of washing the body, carrying the body, travelling in the hearse, at the grave side or entering the grave to lower the remains of the deceased into the grave. My participation in any of these is a part of my Islamic faith.*

Yes

By submitting this form I acknowledge that I understand & accept the above terms and conditions and acknowledge that the information provided is correct*

Yes

I understand that MFS will arrange an Imam or suitably qualified person to perform the Janaza prayer taking place at our facility at the Kuraby Musjid. If the prayer is taking place at the Cemetery or any other Musjid then the family or NOK will have to make the necessary arrangement with the local Imam.*

Yes

The NOK will have to make your own arrangements for someone to perform the Dua or supplication at the graveside.*

Yes

I understand that MFS provides services in accordance with Sunni Islamic practice and principle and will not emulate any practice or request considered to be outside of generally accepted Islamic practice. MFS will regrettably decline any such request.*

Yes

I confirm that the information provided above is correct and understand it will be used to apply to the Registry of Births, Deaths & Marriages for the issuing of the Death Certificate. By completing and submitting this form, I confirm that I understand and accept all the terms and conditions stipulated.*

Yes

Did the deceased suffer from, or have any potentially infectious or contagious medical illness? (This information is essential to protect our team, and guide them to take extra precaution during the ghusl and burial process).*

Yes **No

MFS usually sends out an SMS, and a posts a message on Facebook of the Funeral. Please confirm if this is acceptable*

AcceptDecline

Kindly provide information regarding access to the home and the Janaza, for us to do the pick up of the Janaza. (Would we require additional assistance, to uplift the Janaza?)*

Low set home with Janaza on lower levelHigh set home with Janaza on upper levelFlat or Apartment, with difficult accessVehicle access without difficultyNo vehicle access or with difficultyAdditional assistance will be required to lift Janaza

If the Janaza is over 100kg we may requires additional personnel assistance or additional equipment during the lifting and ghusl process. As far as you know is the Janaza >100kg

No100-125kg125-150kg>150kg

I hereby give consent to MFS Ltd to make all the necessary funeral arrangements for the deceased including the local council grave booking and to complete all the necessary regulatory paperwork as required by law. The information provided above will be used.

I have been advised of the costs involved, and I accept the I am responsible for the fee and understand that this fee will have to be settled prior to or on the day of burial.

The total fee is approximately $ 6100 (Brisbane) to $ 7000 (Gold Coast) for a normal office hour funeral and up to $ 8000 on weekends and after hours.

These fees consist of predominantly the local council fees & charges, and the balance of ~$1900 are made up of follows - Ghusl facility fee $200, Kaffan $150, Grave preparation Fee $350 and MFS Fee of $1000, fee to AFDA, and a fee paid to the Registry of Births, Deaths & Marriages on your behalf for the issue of the Death Certificate.

The application for the Death Certificate is done by us online to the Department, and the death certificate is sent directly to you within 2-3 weeks. The application is made based on the information provided by you on this form.

MFS is a not for profit organisation, and all fees generated are utilised for the running of the organisation and its activities. Incorrect information submitted by you on this form will result in unnecessary fees and delays.

Appropriate arrangements for the fee settlement must be discussed with MFS once the form is submitted. MFS will only proceed with the necessary bookings once this has been done.

This form, the consent to release form from the hospital or nursing home and the original local council application forms will have to be signed when you meet the MFS representative

I confirm that I have contacted and engaged the services of MFS to act on my behalf, including the pick-up of the deceased, arranging the Council grave bookings, and washing and shrouding of the Deceased.

I understand that I will have to arrange for the Cause of Death Certificate to be issued by the treating Doctor.

I understand that MFS is a Not for Profit entity, and engages the services of Volunteers and Employees for some of its services.

MFS will conduct the service in a dignified, professional manner, within the Sunni Islamic principles.

MFS vehicles / hearses are not traditional hearses, but 'transfer vehicles' and are used for all transfers and the funeral process.

The washing and many services may be provided by a group of volunteers who may not be a part of the Company, but volunteer for the sake of and the pleasure of Allah SWT (God), as part of their faith, under the supervision of MFS Directors.

The washing, shrouding and funeral prayer will usually take place at the Kuraby Mosque facility.

In Islam the funeral and burial process is a community responsibility, so it is traditional that members of the Muslim Community, who are unrelated to the Company or family, may assist at various stages of the process for the sake of their Islamic responsibility and duty.

The family and Next of Kin are encouraged to partake in the entire process in keeping with the burial rites in Islam.

Please advise us of any specific requests.

The washing (Ghusl) facility is a designated area for access by the immediate family / those involved in the washing process. The family must advise if they would prefer to perform the washing themselves or assist in the process.

After the Deceased is washed and shrouded, members of the immediate family may attend and be at the side of the deceased, either within the facility or an area arranged within the mosque precinct.

There is no designated 'Chapel' area for mourners. The funeral prayer is usually outside of the actual mosque area and may be at the section of the Mosque called the ‘Sehen’; outdoors in the car park of the Mosque or at the Cemetery as arranged.

There are no pallbearers in Islam. Members of the family assisted by members of the community assist with moving the Bier of the deceased. This is usually outside the control of MFS or it’s Director or volunteers. If you would like to nominate specific male members of the family please notify us, but make arrangements to ensure that they be there at the appropriate time.

The entire process including time of pick up, washing, prayer and burial has been confirmed and agreed upon between myself and the MFS team.

The burial time can only be confirmed once we have possession of the deceased’s Janaza, and have confirmation from Council regarding the grave availability.

The local Councils charge additional fees for burials after hours and weekends. These are outside our control and we are not responsible for any delays outside of our control for whatever reason, and the family of the deceased is responsible for these additional fees.

Date & Time form submitted

DayMonthYearHourMinutes

Comments

By signing and submitting this application form, I agree with the terms and conditions and confirm that all the information provided is correct.*

Yes

eSignature

Clear

Type in letters in the field as seen*

MUSLIM FUNERAL SERVICES Ltd (MFS)

1. Details of the Deceased

2. Marriages of the Deceased

3. Parents details of deceased

4. Children of the deceased

5. Next of Kin of Deceased