AsSalaamu 3alaykum,
Please provide the following information:
Please answer all questions if you do not have an answer enter N/A.
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Please select a Funeral Type *

(Fetal means Death before Birth or Fetal Demise)

 
What is the Last Name of the Deceased? *

 
What is the First Name of the Deceased? *

 
What is the Middle Initial?

 
What is the Mothers Last Name *

 
What is the Mothers First Name *

 
What Year was the Mother Born? *

Enter the 4 digit year. Ex. 1945
 
Fathers Full Name *

Last Name, First Name
 
The Parents Nationality. *

 
Gender? *


 
What is the Date of Expiration? *

 
What Year was the Deceased Born? *

 
Where is the Body currently located? *


 
Name and Address of Facility where Body is located. *

Entire full Name and Address with City State and Zip Code
 
Room Number

 
Address where Body is located. *

Entire full Address with Apt number City State and Zip Code
 
What is your Full Name? *

 
What is your Mobile Number? *

Enter only 10 digits no spaces no hyphens Ex. 7185551212
 
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 addition details or instructions if needed.

 
DISCLAIMER *

I certify that my answers are true and complete to the best of my knowledge. I hereby authorize The Janazah Project/Muslim Funeral Services to secure the body of the Deceased.
     
JazzakAllahu Khair.
That is all the information we need.
We will be contacting you shortly.
Please check your email for further instructions.
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