AUTHORITY TO RELEASE DECEASED

AUTHORITY TO RELEASE DECEASED BODY
The Medical Superintendent of the:*
Select Hospital
Specify Name of any other Hospital or Nursing Home:

0/100
Full Legal Name of Deceased:*

PrefixFirst Name/sMiddle NameLast Name
Date of Birth of Deceased*

DayMonthYear
Date
Gender:*

MaleFemale
Last Address of Deceased*

Street Address

Street Address Line 2

CityState

Post Code
Mothers Name | For Stillborn baby only)

PrefixFirst Name/sLast Name
Full Name Next of Kin*

PrefixFirst Name/sLast Name
I, the Next of Kin (named here), and whose signature follows, being the next of kin / personal representative and the person responsible for making the funeral arrangements for the Deceased named above, authorise MUSLIM FUNERAL SERVICES Ltd to take possession of the body of the deceased for the purpose of conducting the funeral arrangements and burial.
Date

DayMonthYear
Signature of Next of Kin*

Clear
Full Name Next of Kin*

PrefixFirst Name/sLast Name
Should be Empty: