Sta. Maria Auxilliadora Parish

NOTE: Please fill out the fields correctly. Put N/A if not applicable.

A. Information of the Deceased:

First Name:

Middle Name:

Last Name:

SISA:

Address:

Age:

Tithing member:

Date of Death:

Reason of Death:

Father:

Deceased?:

Mother:

Deceased?:

SIBLINGS:

Order of Birth:

Spouse:

Deceased?:

Years of Marraige:

CHILDREN:

No. of Grandchildren:

No. of Great Grandchildren:

Catholic?:

Attending Church?:

Sick?:

Attendant:

PULOT?:

Work:

Position:

Contact no.:

B. Funeral Schedule:

Date of Funeral:

Time of Funeral:

C. Upload Documents:

Death Certificate:

Burial Permit:

Please prepare the following documents:

Death Certificate

Burial Permit

Tithing Clerance/Certificate

Sevices