Authority To Release Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. To: The Director of Medical Services Of (Hospital) *I AM THEPersonal RepresentativeSenior available Next Of Kin and the person responsible for making funeral arrangementsNAME of person authorised to arrange the funeral. *DECEASED Full Legal NameDECEASED Date of BirthDECEASED Gender *SelectMaleFemaleIndeterminateDECEASED Last Residential AddressAuthorise KILLICK FAMILY FUNERALS to take possession of the body of the deceased, for the purpose of conducting funeral arrangements.Name of Person SigningDate DECEASED DECEASED FAMILY Signature Clear Signature Submit
