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Pre-Arrangement Form
Your Information
Date Information Collected
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Full Name
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Address
Address
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City
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Country
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State/Province
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Zip/Postal code
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Phone Number:
Date of Birth:
City of Birth:
Birth Province:
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AB
BC
MB
NB
NL
NS
ON
PE
QC
SK
NT
NU
YT
Social Insurance Number
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Marital Status
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Married
Single
Widow
Divorced
Spouse's Information
Spouse's Name:
Spouse's Maiden Name:
Family Information
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's Maiden Name:
Mother's City of Residence:
Children’s Names and contact numbers
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Grandchildren’s names
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Siblings
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Other people to be mentioned in the newspaper
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Work & Education
Education:
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College
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Your Occupation:
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Military Information
Branch of Service:
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Canadian Army
Royal Canadian Air Force
Serial Number:
Date Enlisted:
Rank at Discharge:
Date Discharged:
Discharge on File at:
Copy of Discharge Papers:
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Funeral Service Information
Place of Service:
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Funeral Home
Church
Cemetery
I Prefer the Funeral Service to be:
Public
Private
Viewing for Family:
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Viewing for Friends:
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Religious Denomination:
Place of Worship:
Lodge or Union:
Disposition Information
I Prefer:
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Burial
Cremation
Entombment
Cemetery:
Address:
Phone:
I Have Made A Last Will & Testament:
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Additional Information
Flower Preference:
Music Selections:
Casket Pallbearers:
Jewelery:
Glasses:
Clothing:
Special Instructions
Other Information:
Memorials & Charities:
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