Pre-arrangement Form

Pre-Arrangements Form

Pre-arrangement Information

Name(Required)

First Middle Last

Name at Birth (if different)(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address City Postal Code

Birthplace(Required)

Date of Birth(Required)

Occupation(Required)

Industry(Required)

Years(Required)

Marital Status(Required)

SIN(Required)

Health Card #(Required)

Name of Husband or Wife(Required)

(incl. Maiden name)

Full Name of Father(Required)

First Middle Last

Father’s Place of Birth(Required)

Full Name of Mother(Required)

First Middle Last

Mother’s Place of Birth(Required)

Physician’s Name(Required)

Do you have a Pacemaker or Other Radioactive Device?(Required)

If Yes, where?(Required)

How many Death Certificates will be required for your estate?(Required)

Clothing – if needed (including undergarments, socks, shoes, etc.)(Required)

Wishes

Burial – Where?(Required)

Funeral – Where?(Required)

Music Requests(Required)

Celebrant Requests(Required)

Additional Info(Required)

Executor/Next-of-Kin to Proceed with Arrangements

Name(Required)

First Middle Last

Relationship(Required)

Phone(Required)

Address(Required)

Street Address City Postal Code

Email(Required)

*We will not use your email address for any purpose other than correspondence regarding these arrangements.

Document Upload

Please upload the following documents:(Required)

1) Will – The page showing executorship and last page showing witness signatures
2) 2 pieces of Identification (Birth certificate, Passport, Driver’s Licence, BC ID)
3) SIN (Social Insurance Number)
4) Care Card (sometimes listed on back of BC ID card)
5) Recent photo (to help us identify and/or prepare for viewing)

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, jpeg, Max. file size: 256 MB.

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Pre-Arrangements Form

Pre-arrangement Information

Wishes

Executor/Next-of-Kin to Proceed with Arrangements

Document Upload