Federation Burial Society Application Form
Applicant Information
Name
*
Mr
Mrs
Miss
Rabbi
Dr
Ms
Prefix
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Town
County
Post Code
Phone Number
*
Please enter a valid phone number.
Format: 00 000-000000.
Email
*
example@example.com
Date of Birth (of applicant)
*
-
Day
-
Month
Year
Date
Please confirm if you are a biological child of a Jewish mother?
Yes
No
Marital Status
*
Please Select
Married
Single
Widowed
Divorced
Please provide both your Hebrew Name and your Father's Hebrew name
Hebrew Name
Father's Hebrew Name
Please complete this section if you are married:
If married, please provide the name of the Synagogue of marriage
Date of Marriage
-
Day
-
Month
Year
Date
Name of Spouse
First Name
Last Name
Date of Birth of Spouse
-
Day
-
Month
Year
Date
Is your spouse a biological child of a Jewish mother?
Yes
No
Hebrew name of Spouse with Father-in-Law's Hebrew name
Spouse Hebrew Name
Father-in-Law's Hebrew Name
Please upload all relevant supporting documents: a copy of your Ketubah (Jewish Marriage Certificate), a Gett, Parent's Ketubah, Conversion Documents, Mother's Conversion Document
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Please complete this section if you have children under the age of 21
Name of Child 1
First Name
Last Name
Date of Birth of Child 1
-
Day
-
Month
Year
Date
Name of Child 2
First Name
Last Name
Date of Birth of Child 2
-
Day
-
Month
Year
Date
Name of Child 3
First Name
Last Name
Date of Birth of Child 3
-
Day
-
Month
Year
Date
Name of Child 4
First Name
Last Name
Date of Birth of Child 4
-
Day
-
Month
Year
Date
Name of Child 5
First Name
Last Name
Date of Birth of Child 5
-
Day
-
Month
Year
Date
Name of Child 6
First Name
Last Name
Date of Birth of Child 6
-
Day
-
Month
Year
Date
Yortzeit Information
Please provide the names and dates of any Yortzeit's you have
Membership Information
Have you ever been a member of the Federation Burial Society?
Yes
No
If yes, state Synagogue and last date of payment
Consent
By signing this form, you agree that all information you have provided is true and accurate. Any information found to be false will affect the status of your membership.
Submit
Submit
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