Funeral Help

Step 1 Please answer all of the following questions
Did the deceased person work professionally in music (now or in the past) for at least 3 years?
- Yes
- No
If yes, please provide a description of the deceased's work in the music industry
Please give us a brief overview of the situation.
Was the deceased person an Australian citizen, permanent resident or on a valid working visa for Australia??
- Yes
- No
Did the deceased person die with no other means available (such as savings or funeral insurance) to pay for his/her funeral?
- Yes
- No
Can you provide the names and contact details of two professional referees (not family or friends) who can verify the deceased person’s career?
- Yes
- No
Step 2 Your Details
Your First Name
Your Surname
Your relationship to the deceased person
Your Address
Your Suburb
Your State
Your Postcode
Your email
Your Phone Number
Your Name
Email
If you have answered no to any of the previous questions, unfortunately you do not qualify for financial assistance at this stage. However we may be able to help you with practical advice on your situation. If you would like us to contact you about this please email us at support@supportact.org.au

If you have answered yes to all the previous questions, we may ask you to show us evidence of this at any stage of your application.

Please continue with your application.
Step 3 REFEREES
Referee 1 First Name
Referee 1 Surname
Referee 1 Email
Referee 1 Phone
Referee 1 Relationship to the deceased
Referee 2 First Name
Referee 2 Surname
Referee 2 Email
Referee 2 Phone
Referee 2 Relationship to the deceased

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Step 4 Please tell us about the deceased person
Title
First Name
Surname
Profession
Profession (Replaced)
Address
Suburb
State
Postcode
Did the deceased person identify as Aboriginal or Torres Strait Islander?
- Yes
- No
Date of Birth
Date Format: DD slash MM slash YYYY
Date of Death
Date Format: DD slash MM slash YYYY
Step 5 Please tell us about the Next of Kin (if not you)
Next of Kin First Name
Next of Kin Surname
Next of Kin Address
Next of Kin Suburb
Next of Kin State
Next of Kin Postcode
Next of Kin Email
Next of Kin Phone Number
Step 6 Please tell us about the funeral
Date of funeral
Date Format: DD slash MM slash YYYY
Location
Funeral Service Provider
Total estimated cost of the funeral
Support Act is rarely able to make a contribution that will cover 100% of the costs of the funeral. If we are able to help, how will the remainder of the costs be met?
We require the following declaration to be made in support of all requests for a contribution towards a funeral. Please read the wording carefully: I declare that I am seeking a contribution to the above named deceased person's funeral on the basis that s/he died without means. I believe that the statements in this application are true in every particular.
Name
Date of Application
Date Format: DD slash MM slash YYYY
Please tick this box to confirm that you have read and understood our privacy and data collection policy which is available on our website at www.supportact.org.au/legal and that you consent to Support Act contacting you about your application and the information you have given us
Please submit your application and we will be in touch.
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Assistance for when you need it most

APPLICATION FORM

Step 1 of 2

Step 1 Please answer all of the following questions

Step 2 Your Details

Step 3 REFEREES

Step 4 Please tell us about the deceased person

Step 5 Please tell us about the Next of Kin (if not you)

Step 6 Please tell us about the funeral

Please submit your application and we will be in touch.