Funeral Services Application

THIS SECTION TO BE COMPLETED BY NEXT OF KIN OR FAMILY REPRESENTATIVE

Today's Date

LEGAL Name of Deceased (Marhum / Marhuma)

Kuniya - Other Name of Deceased (if any)

Date of Death

Address of Deceased (Marhum / Marhuma)

Proof of Death e.g. Medical Certificate of Death from Coroner or Attending Physician or Statement of Death from Funeral Home. Please upload a copy.

Upload (8MB)

LEGAL Full Name of Next of Kin or Family Representative Completing This Form

Phone Contact of Next of Kin or Family Representative Completing This Form

Address of Next of Kin or Family Representative Completing This Form

Email of Next of Kin or Family Representative Completing This Form

This address will receive a confirmation email

Funeral Services Required

Ghusl Kafan (Shroud) Shrouding Coffin / Casket Recitation of Salaat Janazah and Talqeen

Funeral Services Preferences Family will provide a Kafan (shroud) that was requested by the deceased. If you select this option, the Centre Funeral Services Representatives will contact you to coordinate retrieving this from you. Family members wish to participate in the Ghusl and Shrouding. If you select this option, the Centre Funeral Services Representatives will contact you to coordinate this.

Other information Al-Mahdi Islamic Centre Funeral Services Representatives should be aware of

Funeral Services Fees $

Additional Donation Amount $ for Sadaqa Jarriyah in the name of the Marhum / Marhuma.

Total Amount $ for Funeral Services Fees and Sadaqa Jarriyah Donation

Payment Options

Terms and Conditions

By signing this application, I/We agree to the Terms and Conditions below.

1. Al-Mahdi Islamic Centre Funeral Services include ghusl, kafan, shrouding, coffin and leading salaat janazah at the Centre as well as recitation of talqeen at the Cemetery. Al-Mahdi Islamic Centre will also help coordinate with the Funeral Home and Cemetery for timing of the transport of the body of the deceased to/from the Al-Mahdi Islamic Centre.

2. Al-Mahdi Islamic Centre Funeral Services representatives will assist the next of kin by providing contact information for the Funeral Home and Cemetery, if needed. This is necessary in order for the next of kin and family to arrange and pay for for the burial certificate, transportation, purchase of a plot (if required) and other burial related costs. It is the responsibiliy of the next of kin and family to meet the Funeral Home and Cemetery representatives to complete all necessary documentation and arrange for payment of related costs.

3. The next of kin / family consents to Al-Mahdi Islamic Centre's Funeral Services volunteers performing ghusl and shrouding of the deceased.

4. The family consents to Al-Mahdi Islamic Centre collecting and sharing the above information (if required) with the Funeral Home, Cemetery and any other agency where we are required to do so.

THIS SECTION TO BE COMPLETED BY AL-MAHDI ISLAMIC CENTRE SECRETARIAT OR SECRETARY

Application Verification Form details appropriately completed including proof of death. Membership status confirmed for Funeral Service Fees.

Names and Telephone Contact Information of Janazah Volunteers and Family Representatives who participated in the Ghusl / Kafan of the Deceased

Funeral Home Used

Cemetery for Burial

Funeral Services Application

Description

Please Fix the Following