For the Celebration of my Life...
Statement of Wishes
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Statement of Wishes Statement of Wishes
The decisions and choices captured in this booklet
will enable us to help you plan a funeral that truly
HOW WOULD YOU LIKE TO BE REMEMBERED?
When it comes to planning a funeral, people often focus on the practical details,
such as when and where the funeral will be held.
Whilst these issues are very important, many people are also choosing to
emphasise the celebratory aspects of a funeral, such as the style of the service
That’s why we developed this unique Statement of Wishes planning tool. Please
feel free to complete as little or as much of this booklet as you like. The decisions
and choices captured in this booklet will enable us to help you plan a funeral
A STATEMENT OF WISHES CAN BE USED:
a little easier.
By those who wish to complement the practical details included in their
Once completed, we retain your Statement of Wishes in our database for future
reference, which can be changed or converted into a Fixed Price Funeral Plan
at any time.
For more information regarding this unique funeral planning service, please
talk with one of our caring Funeral Advice Line consultants on:
13 19 34.
James MacLeod
Managing Director
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Statement of Wishes Statement of Wishes
Is this booklet being completed in conjunction with a Tobin Brothers Fixed
Price Funeral Plan?
Yes No
PERSONAL DETAILS
Title: Dr Mr
Ms Miss
Mrs Other (please specify on the below line)
Surname: (family name)
Given Name(s):
Surname at Birth:
Sex: M F
Usual Residence:
Phone Number(s)
Home:
Work:
Mobile:
Date of Birth:
Place of Birth:
If born overseas, date of arrival in Australia:
inspiration...
my
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Statement of Wishes Statement of Wishes
I am of Aboriginal or Torres Strait Islander Origin:
No Yes, Aboriginal Origin
Both Yes, Torres Strait Islander Origin
Usual profession or occupation during working life:
Are you retired? Yes No
Are you receiving a pension? Yes No
Name of responsible person after my death:
Address:
Phone Number:
This person is my Executor:
Yes No
If not, name of Executor:
Phone Number:
My Will is located at:
Pension Type: Centrelink Veterans Affairs
Pension Number: (if applicable)
Organ Donor: Yes No
Reference Number:
Marital Status:
Married Widow/er Domestic Relationship Registered
Divorced Never Married Domestic Relationship Unregistered
MARRIAGE(S)
MARRIAGE / DOMESTIC RELATIONSHIP (1)
Given name(s) of Partner:
Surname of Partner:
Male Female
Place of Marriage/Registration:
Date of Marriage/Registration: Not registered
MARRIAGE / DOMESTIC RELATIONSHIP (2)
Given name(s) of Partner:
Surname of Partner:
Male Female
Place of Marriage/Registration:
Date of Marriage/Registration: Not registered
MARRIAGE / DOMESTIC RELATIONSHIP(3)
Given name(s) of Partner:
Surname of Partner:
Male Female
Place of Marriage/Registration:
Date of Marriage/Registration: Not registered
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Statement of Wishes Statement of Wishes
CHILDREN
Provide details of each child in order of birth, including their surname at
birth. Include any legally adopted children. If a child is deceased, enter "D" in
"SB"
1. Child's Given Name(s):
10.
Surname at Birth:
Current Surname:
2. Child's Given Name(s):
10.
Surname at Birth:
Current Surname:
3. Child's Given Name(s):
10.
Surname at Birth:
Current Surname:
4. Child's Given Name(s):
10.
Surname at Birth:
Current Surname:
5. Child's Given Name(s):
10.
Surname at Birth:
Current Surname:
6. Child's Given Name(s):
10.
Surname at Birth:
Current Surname:
7. Child's Given Name(s):
10.
Surname at Birth:
Current Surname:
achievements...
my
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Statement of Wishes Statement of Wishes
PARENTS
Mother/Parent's surname (family name):
Mother/Parent's given name(s):
Mother/Parent's Surname at birth:
Occupation of the Mother/Parent during working life:
Father/Parent's surname (family name):
Father/Parent's given name(s):
Father/Parent's Surname at birth:
Occupation of the Father/Parent during working life:
MY FUNERAL SERVICE
My preference is for my Funeral Service to be conducted by:
Tobin Brothers Funerals Frances Tobin Funerals By Women
Abbey Funerals Herbert King Funerals
I would like my Funeral Service to be held at:
Address:
Phone Number:
I wish to be: Buried Cremated
I wish to Buried/Cremated at:
I own an existing grave/memorial:
Yes
No
If yes, please provide details:
I am the deed holder:
Yes
No
Name:
Address:
Please place my cremated remains at:
I would like the following person to lead my Funeral Service:
Clergy Celebrant Family
Name if known:
Phone Number if known:
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Statement of Wishes Statement of Wishes
Statement of Wishes
1.
2.
3.
4.
5.
6.
I would like the funeral procession to drive past:
My home
Other
PRESS NOTICES
I would like a Death Notice placed in:
The Age
The Herald Sun
Other (please specify)
I would like a Funeral Notice placed in:
The Age
The Herald Sun
Other (please specify)
I would like a Funeral to be private and therefore no Death/Funeral
Notice to be placed.
memories...
my
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Statement of Wishes Statement of Wishes
FLOWERS
Yes
No
charity: (please specify)
CLOTHING
My preference for burial garments are as follows: (please specify)
MUSICAL PREFERENCES
I would like:
Recorded Music Organist
Vocalist Other (please specify)
Piper
Music choices:
ADDITIONAL REQUESTS
Viewing Yes No Family to decide
Rosary Yes No Family to decide
Vigil Yes No Family to decide
Memorial Book Yes No Family to decide
Thank You Cards Yes No Family to decide
Order of Service Yes No Family to decide
Mass Booklet Yes No Family to decide
Memento Card Yes No Family to decide
Audio Visual Presentation Yes No Family to decide
Photo Board/Easel Yes No Family to decide
Candle Lighting Yes No Family to decide
Refreshments Yes No Family to decide
Champagne/Sherry Toast Yes No Family to decide
Other Special Touches:
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Statement of Wishes Statement of Wishes
FUNERAL SERVICE CONTENT
I offer the following information to assist those preparing my tribute/eulogy.
Details of where I grew up are:
Some of my earliest memories are:
The best times I ever had were:
My hobbies & special interests are:
legacy...
my
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Statement of Wishes Statement of Wishes
The most important people in my life are:
Places I worked during my life were:
Some of my life accomplishments are:
Some of the proudest moments in my life are:
passion...
my
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Statement of Wishes Statement of Wishes
I would like the following read at my funeral:
I would like the following life symbols displayed at my funeral:
Medals Art/craft work
Photographs Sporting items
Other (please specify)
Any additional thoughts/information:
Something that most people don't know about me is:
My hobbies & special interests are:
My involvement in clubs/community groups includes:
Lions Rotary
RSL Golf/tennis/bowling clubs
Other (please specify)
service:
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Statement of Wishes Statement of Wishes
remembered?
how would you like to be
The spirit of this booklet is to assist my family and those left behind in
preparing for my funeral service.
I provide permission for my family to make any appropriate changes.
My preference is for these arrangements to remain unchanged.
Signature
Date
On completion of your Statement of Wishes please send the original copy to:
Funeral Advice Line
Tobin Brothers Funerals
PO Box 251
North Melbourne Victoria 3051
We will place your details and requests on our Statement of Wishes database.
We will then forward you the original plus one copy in the mail and recommend
that you place one copy with your other important papers. We advise you to
funeral arrangements.
For further details, or if you would now like to proceed with a Fixed Price Funeral
Plan with Tobin Brothers Funerals, please telephone our Funeral Advice Line
on: 13 19 34 or email your enquiry to: [email protected]
For 24 Hour Service and Enquiries please telephone
our Funeral Advice Line: 13 19 34
www.tobinbrothers.com.au
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