GFF - Application Form Online

Application Form

For Membership in the Gallipoli Funeral Fund Limited
What type of application are you submitting?*

🧍 Single Applicant🧑‍🤝‍🧑 Double Applicants (2 Persons)
Applicant’s Details 📝
Primary Applicant’s Details – Double Facility
Title (Mr, Mrs, Miss, Ms)*
Name*
Gender*
Date of Birth*

DayMonthYear
Date
Terminal Illness?

NoYes
Today Date

DayMonthYear
Today
🏠 Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
📬 Correspondence Address (if different from Residential Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
📧 EmailAddress*
📞 Mobile Number*
Please enter a valid phone number.
☎️ Home Phone Number
Please enter a valid phone number.
Were you referred by an individual/organisation?

YesNo
Please provide the name of the referring individual or organisation.
As at the date of this application, I confirm and declare that:

I permit my beneficiaries to receive a payout if they choose not to arrange my burial through NSW United Turkish Islamic Centre Inc.
Do you wish to be buried at Rookwood Cemetery?

YesNo
Please note: Burials at Rookwood Cemetery attract an additional fee of $2,500 for a Single Facility.
This amount is added to your entry fee and can be paid upfront or in instalments with your membership.
Please note: Burials at Rookwood Cemetery attract an additional fee of $4,500 for a Double Facility.
This amount is added to your entry fee and can be paid upfront or in instalments with your membership.
Do you have a preferred cemetery location? Please specify (Optional)

👤 Primary Nominee’s Details

I nominate the following person who will, upon my death, be authorized to provide directions to GFF relating to my funeral services and/or burial and, if I devise a Will, this person is intended to be appointed as its executor:
Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*
Please enter a valid phone number.
Relationship with Applicant*
Email Address*

👥 Secondary Nominee’s Details

If the nominee named above does not survive me or is unwilling to act as my nominee, I nominate the following person to be authorized, upon my death, to provide directions to GFF regarding my funeral services and/or burial. If I have a Will, this person is also intended to be appointed as its executor or substitute executor.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number
Please enter a valid phone number.
Relationship to Applicant:
Email Address
Referral Code
Age of Member

Secondary Applicant’s Details – Double Facility
Title (Mr, Mrs, Miss, Ms)*
Name*

First NameLast Name
Gender*
Date of Birth*

DayMonthYear
Date
Terminal Illness?

NoYes
🏠 Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
📬 Correspondence Address (if different from Residential address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
📧 Email Address*
📞 Mobile Number*
Please enter a valid phone number.
☎️ Home Phone Number
Please enter a valid phone number.
As at the date of this application, I confirm and declare that:

I permit my beneficiaries to receive a payout if they choose not to arrange my burial through NSW United Turkish Islamic Centre Inc.
I choose to be buried at:

👤 Primary Nominee’s Details

I nominate the following person who will, upon my death, be authorized to provide directions to GFF relating to my funeral services and/or burial and, if I devise a Will, this person is intended to be appointed as its executor:
Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*
Please enter a valid phone number.
Relationship with Applicant*
Email Address*

👥 Secondary Nominee’s Details

If the nominee named above does not survive me or is unwilling to act as my nominee, I nominate the following person to be authorized, upon my death, to provide directions to GFF regarding my funeral services and/or burial. If I have a Will, this person is also intended to be appointed as its executor or substitute executor.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number
Please enter a valid phone number.
Relationship to Applicant:
Email Address
Age of Applicant 2

The fees are calculated based on your Age: {calculation}, Application type: {whatType}, Terminal illness status.

Here you can check your full rates in the Product Disclosure Statement (PDS).
Entry Fee
Rookwood Cemetery Fees
Entry Fee :
Annual Premium
${entryFee161}
${entryFee}
Payment Plan
Entry Fee Payment Plan*

UpfrontAnnual InstalmentsQuarterly InstalmentsMonthly Instalments
Annual Premium Plan*

YearlyMonthly
Note:

• Upfront – Pay the full amount at the time of joining
• Annual Instalments – Pay the entry fee in 3 equal yearly payments over 2 years: first on joining, second on your 1-year anniversary, and third on your 2-year anniversary
• Quarterly Instalments – Pay the entry fee in 8 equal quarterly payments over 2 years
• Monthly Instalments – Pay the entry fee in 24 equal monthly payments over 2 years
Entry Fee Today
Annual Premium Today
${entryFeetoday}
${annualPremiumtoday}
Total :
${calculation124}

My Products*

AUDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

I declare and confirm that*

I have read and understood the Product Disclosure Statement relating to Gallipoli Funeral Fund Limited Offer of Membership.To the best of my knowledge and belief, the information I have provided in this application form is true and correct
Should be Empty:

Application Form

Applicant’s Details 📝

Primary Applicant’s Details – Double Facility

👤 Primary Nominee’s Details

👥 Secondary Nominee’s Details

Secondary Applicant’s Details – Double Facility

👤 Primary Nominee’s Details

👥 Secondary Nominee’s Details

EntryFee

Annual Premium

Payment Plan