Planning Form / Funeral Information

Contact Email:
A copy of this form will be emailed to the following address:
A value is required.Invalid Email format.

Final Arrangments for:
Full Name*:
A value is required.
Sex*: Female
Street Address*: (If rural, please give exact location not Post Office/Rural Route Address)
A value is required.
City, town or other place*:
A value is required.
Province / State*:
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Country*:
A value is required.
Postal Code*:
A value is required.
Personal Health Number*:
A value is required.
Social Insurance Number*:
A value is required.

Vital Information About the Person for Whom Pre-planning Is Being Done:
Marital status:
Married Separated
Divorced Common-law

Full Name of Husband or Maiden Name:
Occupation:
Birthdate (m/d/y)*:
A value is required.
Birthplace (city, town or other place)*:
A value is required.
Province / State (or country) of birth*:
A value is required.
Birthname if different (surname):
All given names:
Father's surname and given names:
Father's birthplace:
Mother's maiden name and given names:
Mothers's birthplace:
Family physician's name:

Person(s) To Finalize Arrangements At Time of Death:
Name of next-of-kin or executor:
Address:
Postal code:
Telephone:
E-mail Address:
Additional information:

Funeral Service Information:
Type of Arrangement*: (check appropriate box)
Funeral Service
Memorial Service
Open Casket
Graveside Service
Closed Casket
No Service

I request that the Service be held in:

Name of Church OR Assembly Facility:
Address:
Clergy:

Disposition Options:
I request my body be*:   Buried
If Burial, please specify name of cemetery:   
I already own burial property at the above cemetery: No
If Cremation, I wish that my cremated remains be:
Buried and memorialized in family plot or cremation plot.
Permanently scattered on land
Permanently scattered at sea
Returned to my family or executor
Other, please specify below

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