Order form

Deceased person
Deceased person * Fill in name, first name and civil status of the deceased
Date of birth * Select the date of birth of the deceased Place of birth * Complete the city of birth of the deceased
Death date * Select the date of death
Place of death * Fill in place of death as well as the zip code and the city
Domiciled in * Complete the official address of the deceased
National number
Civil status *
of * Fill in name, first name and civil status of the partner of the deceased
Details about the funeral and ceremony
Type of funeral Coffin type * Select the type of the desired coffin
Cemetery * Complete the municipality where the funeral will take place
Ceremony required
Price of funeral (excluding municipal taxes) :
We undertake to pay on your behalf any taxes arising from the municipalities and/or crematorium.
2000.00 €
Contact person
Relationship *Complete your family relation with the deceased
Contact person * Complete your name, first name and civil status
Address * Complete the address to which we shall send the invoice
E-mail address *Complétez l'adresse e-mail où nous pouvons vous contacter Telephone *Complete your telephonenumber or mobile
Check this box to confirm your order
In the event of natural death, we will undertake to proceed with the funeral as soon as possible.

After sending your order, a confirmation e-mail will be sent to you.
We will contact you by phone as soon as possible to confirm the date and time of the funeral.