Automated Funeral Form

LMA FUNERAL PARLOUR

Deceased Information
PLEASE NOTE:

If the grave is a re-open, please ensure the form is filled by the original owner/ executor of the grave.

Details must be filled in by Next of Kin (Wife, Husband, Mother, Father, Son, Daughter, Brother, Sister or Legal Representative).

Our Funeral Director will liaise with the Next of Kin only for all burial related matters.

If the Deceased is located at the Coroners, please provide details of who the Coroner liaised with (family member and contact number below).

Please fill in all the required details below so that we can assist in the preparations for the burial of your loved one.

If you have any questions, please do not hesitate to reach out to one of our LMA Funeral Staff.
Deceased Details
Is the Deceased A still born?*

YesNo
Mothers Full Name

First NameLast Name
Title*

MrMrsMsMiss
Deceased Full Name*

First NameLast Name
Has the deceased ever used or been known by any other name (eg: name at birth, maiden name, previous married name?)*
Deceased Last Known Address (Please include Postcode)*

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Deceased - Date of Birth*

DayMonthYear
Date
Deceased - Date of Death*

DayMonthYear
Date
Deceased - Age at Death
Sex of the Deceased*

MaleFemale
Deceased Marital Status*

Child Not ApplicableSingleMarriedDivorcedWidowDefacto
Deceased - ID type 1*

Drivers LicencePassportPhoto IDMedicare Card
Deceased ID Number 1*
Deceased - Drivers Licence, Passport, Medicare Card or Photo ID 1*

Cancelof
Deceased - ID type 2*

Drivers LicencePassportPhoto IDMedicare Card
Deceased ID Number 2*
Deceased - Drivers Licence, Passport, Medicare Card or Photo ID 2*

Cancelof
Deceased pick-up details
Pick up location:

HospitalNursing HomeCoronerResidential
Pick up location: Name of Nursing Home
Pick up location: Hospital
Pick up location Address:*

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Coroner
Pick up location: Name Coroner
Family member who liaised with the Coroner*
Family member who liaised with the Coroner - Relationship to Deceased*
Family member who liaised with the Coroner - Contact Number*
Next of Kin Details
Next of Kin Full Name*

First NameLast Name
Relationship to the Deceased*
Next of Kin - ID Type 1*

Drivers LicencePassportPhoto IDMedicare Card
Next of Kin ID Number 1*
Next of Kin Photo ID 1 - Drivers Licence, Passport Medicare Card or Photo ID*

The person who is the Next of Kin must be the same person listed at the Hospital and or Coroner
Cancelof
Next of Kin - ID Type 2*

Drivers LicencePassportPhoto IDMedicare Card
Next of Kin ID Number 2*
Next of Kin Photo ID 2 - Drivers Licence, Passport Medicare Card or Photo ID*

The person who is the Next of Kin must be the same person listed at the Hospital and or Coroner
Cancelof
Has the Next of Kin ever used or been known by any other name (eg: name at birth, maiden name, previous married name?)*
Next of Kin Date of Birth*

DayMonthYear
Date
Next of Kin Contact Number*
Next of Kin Email*
example@example.com
Next of Kin Address*

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Overseas or Interstate Burial
Will the Deceased be buried overseas or Interstate?*

YesNo
For Overseas- Please provide an international family members name and number:
If this is an overseas or interstate repatriation, please let us know the location the deceased will need to be sent to.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Religious Services
PLEASE NOTE: Burials that take place before the Friday Jummah Prayer, we cannot guarantee a Sheikh to be available to attend the burial. It is recommended that the family organise their own Sheikh for burials before Dhuhr prayer - Daylight and non Daylight saving times.
Would you like the LMA to request a Sheikh to attend the Funeral Service? (If your deceased loved one is a child/baby, please discuss this with the Funeral Director)*

YesNoFamily will organise their own Sheikh
Cemetery Details
Is the burial on a Weekend or Public Holiday?*

YesNo
Please choose which Cemetery you wish to bury your loved one*

Rookwood CemeteryNarellan CemeteryKemps CreekLeppington (Forest Lawn)Minchinbury (Pinegrove)Other
Rookwood

Angel Baby (0-20 weeks)Angel Baby (0-20 weeks)Children (1 year - 11 years)AdultAdult InternmentN/A
Rookwood Weekend Public Holiday

Angel Baby (0-20 weeks) - PHAngel Baby (0-20 weeks) - PHChildren (1 year - 11 years) - PHAdult - PHAdult Internment - PHN/A
Narellan

Angel Baby (0-20 weeks)Angel Baby (0-20 weeks)Children (1 year - 11 years)AdultAdult InternmentN/A
Narellan Weekend Public Holiday

Angel Baby (0-20 weeks) - PHAngel Baby (0-20 weeks) - PHChildren (1 year - 11 years) - PHAdult - PHAdult Internment - PHN/A
Leppington (Forest Lawn)

AdultAdult Internment
Michinbury (Pinegrove)

AdultAdult Internment
Please be advised there may be additional fees for longer travel distances.
Re-Open Grave
If you have previously purchased a grave at Rookwood or another cemetery, and you want to request a reopen*

YesNo
Name of deceased previously buried
Grave number details
PLEASE NOTE: IF THE BURIAL IS FOR A REOPEN, PLEASE ALLOW 4-6 HOURS TO DIG UP THE BURIAL PLOT.
Please note: The LMA Funeral Parlour will lodge the DRS form on your behalf which is included in your burial package.Please complete and return to funeral@lma.org.au

You will also receive via email your invoice|receipt and lodgement number for your reference.

For the Death Certificate, please contact Births Deaths and Marriages.

https://www.nsw.gov.au/family-and-relationships/deaths/death-certificates
Consent
I authorise for the LMA Funeral Parlour to collect my family member and transport them back to Lakemba LMA Funeral Parlour to commence the burial process.*

YesNo
Please sign to acknowledge that the information above is correct and that you give the LMA Funeral Parlour the Authority to collect the Deceased and proceed with the burial.*
Should be Empty:

LMA FUNERAL PARLOUR

Deceased Details

Deceased pick-up details

Coroner

Next of Kin Details

Overseas or Interstate Burial

Religious Services

Cemetery Details

Re-Open Grave

Consent