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)


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)


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

Metal Hard Wood Other

Other enclosure
Metal Concrete Other


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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