Paperbark Pre Arrangement Form

Pre Arrangement Form
It may be helpful to make a cup of tea & slowly go through these questions, there is no rush in this moment especially if death has just occurred. If for any reason you feel overwhelmed by this form please call us & we can go through it question by question with you.

The details are needed for issuing legal documentation such as the Death Certificate & liaising with varying departments. It also helps us to get an idea of what your needs & requests are at this time if we have not yet been in contact.

If you are uncertain about some answers & have no way of finding out, ‘unknown’ is sufficient. To ensure that we have all the details for necessary paperwork, please double check all spelling of names, addresses & information is correct as this is what will be entered with Births Deaths & Marriages for the Death Certificate to be issued.

Please nsure you have pressed submit at the end of the form we will be in contact to confirm that we have received it.

Please call 0466 526 156 if you are needing guidance here.
Authorisation Statement

Please fill in your details below and sign the authorisation request which allows us to bring your person into our care.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
You are the (mark all relevant)*

ExecutorNext of KinApplicantOther
Who is the Executor*
Relationship*
Date of birth*

DayMonthYear
Current Age*
Driver's License Number*
Date signed*

DayMonthYear
By signing this document, you authorise Paperbark Deathcare to: Collect your loved one. Bring them into our care. Arrange for their cremation or burial. Collect their ashes (for cremation only).

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The following questions will help us gather the personal information of your loved one who has passed, is nearing the end of life, or is preparing pre-need documents. If you're unsure about any question, please write N/A, and we can gather that information later together.
Family name*
Family name at birth/maiden name*
First given name*
Middle/Other given names
Sex*

MaleFemaleIntersexIndeterminateNon specific
Age at Date of Death*
Date of Birth*

DayMonthYear
Date of Death (if not yet passed please do date of birth again)*

DayMonthYear
Cause of Death - if death has not yet occurred, please let us know the current situation. If cause of death is coronial, please write 'coronial.'*
Did death occur in a NSW Hospital or Nursing Home*

YesNo
Place of Death - address of where death occurred or where you anticipate the death may occur*

Street Address

Street Address Line 2

CityState

Post Code
Usual Residential Address*

Street Address

Street Address Line 2

CityState

PostCode
If born outside of Australia, number of years lived in Australia
Occupation in working life*
Place of birth - town, state & country*
Retired at date of death*

YesNo
If on a pension, please indicate which type or N/A*
Aboriginal & Torres Strait Islander origin*

AboriginalTorres Strait IslanderBoth Aboriginal & Torres Strait IslanderNeitherUnknown
Marital Status at Time of Death*

De FactoMarriedDivorcedNever MarriedWidowedUnknown
Please record current and all previous marriage or de facto relationships: Place of marriage - Age at marriage or when de facto relationship began - Country - Suburb/Town/City - Spouse Family Name - Spouse Given Name/s - Spouse Gender
Number of children (do not include step children, only note birth children and legally adopted children)
Children's Details - from Eldest to Youngest - Family Name - First Given Name - Life Status (Alive, Deceased or Unknown) - Gender (do not include step children, only note birth children and legally adopted children)
Parent 1 (this is the parent of who has passed/or passing)*

First NameLast Name
Parent 1 Maiden Name (this is the parent of who has passed/or passing)*
Parent 1 sex*

MaleFemaleIntersexIndeterminateNon specific
Parent 1 life status*

AliveDeceasedUnknown
Parent 1 occupation in working life*
Parent 2*

First NameLast Name
Parent 2 sex*

MaleFemaleIntersexIndeterminateNon specific
Parent 2 life status*

AliveDeceasedUnknown
Parent 2 occupation in working life*
Usual doctor, address & phone number or last visited doctor/medical centre*
Does the deceased have a pacemaker or defibrillator fitted?*

YesNoUnsure
Has the deceased person received any radiopharmaceuticals or radioactive compounds for therapeutic purposes within the past 12 months?*

YesNoUnsure
Height & weight (we require height and weight for transfers and casket sizing)*
Is there a prepaid or funeral bond in place? If yes, please provide contact details
What service would you like? You may select more than one.*

Paperbark Direct No Attendance CremationPaperbark Direct Cremation with viewingPaperbark Cremation with small Intimate CeremonyPaperbark Cremation with Ceremony/Funeral/MemorialPaperbark Direct BurialPaperbark Burial with Ceremony/Funeral/MemorialHome Vigil - POACeremonialist onlyUnsure - would like to discuss
Are there any additional requests or instructions for deathcare & funeral arrangements?
What sort of coffin/casket/shroud would you prefer?*

Paperbark Pod - shroud on bearer wrapped in PaperbarkBioboard Casket - this is what is used for all Direct No Attendance CremationsWicker HandwovenNatural Eco Wooden / PineTraditional StyleUnsure - would like to discuss
Any other additional information you would like us to know?
How did you know about Paperbark Deathcare? Example friend or family, instagram, Google search*
By signing this form, you are entering into a service agreement with Paperbark Deathcare to carry out the burial or cremation and any associated ceremony as discussed. This agreement gives us permission to make necessary arrangements on your behalf, including coordinating with external service providers. Please note that invoices are due upon receipt, as we are required to pay our suppliers — such as cemeteries, crematoria, florists, and other vendors — at the time of service. In some cases, a 50% deposit may be required before certain arrangements can proceed. We appreciate your understanding and timely attention to these matters.*

Agree
Next steps

Contact me to set up an appointment or telephone conversationSend me a quote for servicesNo appointment necessary, I am getting organised & would like you to keep these details on file
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Pre Arrangement Form

Authorisation Statement