Funeral Request

Funeral Type :

What is the Last Name of the Deceased? * :

What is the First Name of the Deceased? * :

What is the Middle Initial of the Deceased? * :

Gender :

Date of Expiration :

Date of Birth of Deceased :

Religion :

Where is the Body Currently Located? :

Address where Body is located. *

What is Your Full Name?

What is your Relationship to the Deceased? *

What is Your Mobile Number?

What is Your Email Address?

What is Your Full Home Address?

Do you wish to decline any Autopsy from Medical Examiner due to Religious Restrictions?

Do you wish to decline the taking of blood or other fluids by any means?

Will the Deceased be buried overseas?

Please provide any additional details or instructions if needed.

Disclaimer : I certify that my answer are true and complete to the best of my knowledge. I hereby authorize The Janazah Project/ Muslim Funeral Service to secure the body of the Deceased.