Bereavement Form

Our sincere condolences to you and your family. Please fill in this form and submit it so that we can aid you as quickly as possible during this time of loss.

Requestor Information

Full Name

Phone

Membership Status

Please select one option.

Member Non-Member

Relationship to the deceased

Please select one option.

Spouse Child Parent Sibling Grandparent

If you're a member of Lighthouse Evangelism, please provide us with your Cell Leader's name.

CGL

Details of the Deceased

Date of Passing (DD/MM/YYYY)

Time of Passing

Full Name of Deceased

Membership Status of the Deceased

Please select one option.

Member Non-Member

If Deceased is a member of Lighthouse Evangelism, please provide the name of his/her Cell Leader and the ministry he/she is currently serving in

CGL

Ministry that Deceased was serving in

One other family member who are attending Lighthouse Evangelism

Name of other family member

Contact No. of other family member

Funeral Details

Wake Venue (Address)

Date that body will be sent to Wake Venue (DD/MM/YYYY)

Time that body will be sent to Wake Venue (For E.g, 3:30pm)

Wake (Night) Service

Date (DD/MM/YYYY)

Time (For E.g, 3:30pm)

Funeral Service

Date (DD/MM/YYYY)

Time (For E.g, 3:30pm)

By submitting this form, I give consent to Lighthouse Evangelism to collect, use and disclose my personal data for purposes of facilitating and communicating with me.

Please select all that apply.

I Agree

Description

Our sincere condolences to you and your family. Please fill in this form and submit it so that we can aid you as quickly as possible during this time of loss.

Bereavement Form

Description

Please Fix the Following