It's Your Funeral 

DECLARATION

I, the undersigned state that this Funeral Self-plan contains

an accurate record of my wishes with regard to the making

of arrangements for my funeral.

I also state that no pre-payment has been made for the funeral

 outlined in this plan unless an appropriate payment certificate

 is attached herewith.

Signed:            __________________________________________

Dated:             __________________________________________

Witnessed by:  __________________________________________

Dated:             __________________________________________