Please fill in
the details below.
Required fields are marked with an asterisk (*).
A:
Details of the Deceased
*First
name:
*Middle
Name(s):
*Surname:
Date
of birth:
Day
Month
Year
Place
of birth:
Date
of death:
Day
Month
Year
Place
of death:
Where
the deceased was cremated/buried:
Note: if the deceased's
funeral service was not conducted at any of the
Metropolitan Cemeteries Board's facilities (Karrakatta,
Pinnaroo, Midland, or Guildford) a copy of the death
certificate or certificate of cremation will be
required with this application.
B:
Details of the Memorial Purchaser
*First
name:
*Middle Name(s):
*Surname:
Street Address:
City/Town:
State:
Postcode:
*Home
Telephone:
e.g. 08 9876 5432
Work
Telephone:
e.g. 08 9876 5432
E-mail:
Relationship of the
memorial purchaser to the deceased (optional):
C:
Memorial Package Options
Please
Note:
The Memories e-ternal Memorial
Package includes up to 3000 words of text and
3 photos.
Additions/Changes can include
up to 12,000 words of text, up to 13 photos in
total, up to 10 minutes of video and up to 5 minutes
of audio.
D:
Memorial Content
Please indicate below
the items you would like us to include in your
on-line memorial:
Item:
Eulogy
Photos and Captions
Pages of Text
Poetry
Audio
Video
Other (please specify):
Memorial purchasers
are asked to provide these items to the Metropolitan
Cemeteries Board along with this application and
payment. If you able to provide any or all of
these items electronically on floppy disk, please
do so. If you are not able to provide these items
electronically, we will scan them and return the
originals to you within one week of receiving
your memorial request.
A guestbook is standard
with all on-line memorials. Once your memorial
is created, we will provide you with a password
which you may pass on to your friends or family
at your discretion.
E:
Payment
The Metropolitan Cemeteries
Board will be developing a secure online payment
facility as a future enhancement to this site.
In the interim, the following payment options
are available.
Please complete the form below to indicate how
you intend to pay for your on-line memorial.
Please select one of
the options below.
Method:
Cheque (made payable to
the Metropolitan Cemeteries Board)
Money Order
Bankcard
Visa
Mastercard
Cash (only if you are paying in person)
If paying by credit
card:
Name of Cardholder:
Card Number:
Expiry (MM/YY e.g. 12/09):
Amount ($AUD):
Standard ($545.60 including GST)
Standard plus 1 Addition/Change ($628.10 including
GST)
1 Addition/Change only ($82.50 including GST for
each addition)
Please print out and
complete this application form with the appropriate
fee and post to:
Metropolitan
Cemeteries Board
PO Box 53
Claremont 6910
Or, bring your form,
memorial items and payment to our office at Karrakatta
Cemetery and lodge your on-line memorial application
in person. It is recommended that you telephone
in advance to make an appointment. Call (08) 9383
5200 and ask to speak to a Memorial Consultant.
Memorial Application
Checklist:
Before you submit your
application to the Metropolitan Cemeteries Board,
please ensure that you have included the following:
Completed application
form (Sections A, B and C)
All memorial
content, including text and images (Section
D)
Your payment
(Section E)
Death Certificate
or Certificate of Cremation for the deceased
(if the funeral service was not conducted at
any of the Metropolitan Cemeteries Board's facilities
- Karrakatta, Pinnaroo, Fremantle, Midland or
Guildford).
