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 Birth of of authorised DECEASED 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 Signature Clear Signature Submit
