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Admission Form - Part 2
CALL 02 4967 1060
APPLICATION FORM ADMISSION PART 2
Funeral Arrangements
The executor/s under my Will is/are:
(This is for the purpose of refunding accommodation bond and other financial arrangements)
Name
Phone
Address
Postcode
Extra Service
Would you like a newspaper?
Yes
No
Deliver
Monday
Tuesday
Wednesday
Thursday
Friday
Clothing Labels
Clothing Labels can be purchased for $1 per label. Our staff will print and professionally attach to clothing
using our label press, on your behalf.
Please indicate the number of items you anticipate you will have on admission day. Any excess labels printed and not used will be stored for later use at times when new items are added to the wardrobe.
Please note all items must be labelled. Socks, underwear, jumpers etc.
105
72
36
Permission to print extra clothing labels
Please indicate the number of extra labels for us to print if the excess labels mentioned above run out and we need to print more. These will be charged to your account.
20
15
10
Signature and Declaration
By signing this Application, you declare that the information given in this form is true and complete, you give the undertaking set out above in relation to change to any Power of Attorney and/or appointment of Guardian or Financial Manager and you provide the privacy consent set out above.
Signature of Applicant
Reset Signature
Reset Signature
Date Signed
Was this form filled out by an authorised signatory? (E.g., Guardian, Attorney, or person responsible).
Yes
No
Name of authorised signatory
Date
SUBMIT
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