| Vital Statistics |
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Last Name: |
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First Name(s): |
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Social Insurance No: |
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Address: |
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City: |
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Province: |
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Postal Code: |
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Phone No: |
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email: |
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Date of Birth: |
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Place of Birth: |
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Marital Status:
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Spouse's Last Name:
(wife's maiden name) |
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Spouse's First Name(s): |
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Father's Full Name: |
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Father's Birthplace: |
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Mother's Full Name:
(maiden name) |
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Mother's Birthplace: |
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Occupation: |
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Employer: |
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Military or Naval Service: |
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Service Number: |
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Membership in any Clubs or Fraternal Groups
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Please list involvement in any Community Groups etc.
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Should these be mentioned in the death notice?
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Name, Address and Phone Number of Lawyer: (will)
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Name, Address and Phone Number of Executor(s):
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Name, Address and Phone Number of Next of Kin:
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For the benfit of your family and executor you may wish to list any life insurance policies, pension plans, bank accounts, investment certificates, RRSPs, Stocks, bonds or any pertinent information for your estate matters:
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Funeral Plans
It is my understanding that while these plans are not legally binding, they are to serve as a guide to my family or executors and that the following represents my personal wishes as to my funeral arrangements. |
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Service to be held at:
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If church, name of church: |
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with:
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Name of Cemetery: |
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in City/Town of: |
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Service to be conducted by:
(Name of Clergy) |
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Name of Church: |
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Length of Visitation:
If Other:
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Post Funeral Reception to be held at:
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Musical Requests: Hymns to be sung
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Musical Requests: Hymns to be played
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Previously recorded music to be used at
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Type of casket:
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If burial, outer container:
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If cremation, urn:
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If cremation, urn vault:
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Possible Pallbearers:
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Newspapers in which a death notice should appear:
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Memorial Donations should be directed to:
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Survivors - list in order of age and include addresses and phone numbers as well as their spouses' names -
(this will be updated at need) |
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Spouse:
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Sons ( include addresses and phone numbers
and spouses' names):
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Daughters (inlcude addresses and phone numbers
and spouses' names
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Grandchildren ( include cities/towns
and spouses' names
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Great Grandchildren (include cities/towns
and spouses' names
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Sisters (please include cities/towns
and spouses' names
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Brothers (please include cities/towns
and spouses' names
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Others:
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Predeceased by:
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Special Requests/Notes:
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Pre-Arrange Online
