Bereavement Form 丧礼服事要求

Our sincere condolences to you and your family during this difficult time. Please fill out and submit this form so that we can assist you as quickly as possible.  我们向您和您的家人表达深切的慰问。请填写及提交此表格，以便教会能尽快提供协助。

Requestor Information 家属资料

First Name 英文名字

Surname 英文姓氏

Contact No. 联系号码

Membership Status 会员资料

Member 会员

Non-Member 非会员

Relationship to the deceased 与已故者的关系

Spouse 配偶

Child 孩子

Parent 父母

Sibling 兄弟姐妹

Others 其它

If indicated Others, please specify. 如选择其它,请注明。

If you are currently attending a cell group, please provide us with your cell leader's name. 如您有参加小组，请提供组长的名字。

Details of the Deceased 已故者的资料

Name of Deceased 已故者姓名

Date of Passing (dd/mm/yyyy) 去世日期（日/月/年）

Time of Passing 去世时间

Membership Status of the Deceased 已故者的会员资料

Member 会员

Non-Member 非会员

Funeral Details 葬礼细节

Wake Venue (Address) 已故者追思地点

Date that body will be sent to Wake Venue (dd/mm/yyyy) 已故者遗体抵达追思地点的日期

Time that body will be sent to Wake Venue 已故者遗体抵达追思地点的时间

Do you require the church to conduct the wake service? 您是否需要教会主持追思会？

Yes 需要

No 不需要

Wake Service (Night) Date (dd/mm/yyyy) 晚间追思会的日期

Wake service Time 追思会时间

Do you require the church to conduct the funeral service? 您是否需要教会主持葬礼仪式？

Yes 需要

No 不需要

Funeral Service Date (dd/mm/yyyy) 葬礼仪式日期

Funeral Service Time 葬礼仪式时间

Remarks 备注

By submitting this form, I permit Lighthouse Evangelism to collect, use, disclose or otherwise process my data for church administration and other purposes, in accordance with the Personal Data Protection Act (PDPA). 呈交此表格即表示我准许灯塔教会遵照个人资料保护法令（PDPA）在行政上收集；使用我的个人资料。

I Agree 我同意