Preplanning Form

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Your Contact Information
Email Address*:


Confirm Email Address:


Your Personal Information
Last name*


First and middle names*


Date of birth (yyyy/mm/dd)

Birthplace 

Social Insurance Number


Street (911) Address


Mailing Address


Zip or postal code


Phone number (include area code)


Type of work done most of working life (e.g. teacher)


Type of business or industry (e.g. Education)


Membership in fraternal, civic, or professional organizations (e.g. Legion, Rotary, Masonic Lodge)


Church affiliation and activities (e.g. United, UCW)


Did you serve in the military?
Yes No
If Yes, in which war(s) or conflict(s) did you serve?

Other special events or activities


Your Parents
Father's name


Father's birthplace (city, province)


Mother's maiden name


Mother's birthplace (city, province)


Your Spouse
Spouse's maiden name


Date of marriage


Your Children and Grandchildren
1. Child's name (first and last)


1. Child's spouse (first and last)


1. Child's address (city, province)


2. Child's name (first and last)


2. Child's spouse (first and last)


2. Child's address (city, province)


3. Child's name (first and last)


3. Child's spouse (first and last)


3. Child's address (city, province)


4. Child's name (first and last)


4. Child's spouse (first and last)


4. Child's address (city, province)


Number of grandchildren

First names of grandchildren

Number of great grandchildren

First names of great grandchildren

Your Siblings
1. Sibling's name


1. Sibling's spouse


1. Sibling's address (city, province)


2. Sibling's name


2. Sibling's spouse


2. Sibling's address (city, province)


3. Sibling's name


3. Sibling's spouse


3. Sibling's address (city, province)


4. Sibling's name


4. Sibling's spouse


4. Sibling's address (city, province)


Predeceased by


Your Funeral Preferences
Funeral Home


Funeral Director


Service to be held at (i.e. Funeral Home chapel, Church, other)


Clergy or officiant


Readings and music


Pallbearers (normally six would be acceptable)


Organist


Alternate pallbearer(s)


I prefer the following clothing/jewellery

Eye glasses? Yes No

Expressions of sympathy
Flowers Donations Wishes of survivors

Donations to:

Your Interment Preferences
I prefer
Burial Cremation

Cremation Urn


Casket
Metal Hard Wood Other


Other enclosure
Metal Concrete Other

Cemetery/Crematorium

Location (city and province/state, country if not Canada)

Prearranged burial plot (grave no., plot, section, block, name deed held by)


Payment Options
Please choose a preplanning payment option




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