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This page was last updated: March 30, 2011
FORM 1: At Need Information Form
This is the information we require that allows us to fill out all of the necessary documentation for you.
Please do not be concerned if you only have some of the information. Please fill out as much of the form as you can and any missing information can be submitted at a later time through this form or communicated to our staff over the phone.
These forms are for advanced planning only. If a death has already occurred please call us at 519-935-2754 or 1-888-340-3467
Informant's Information (Please enter the information of the person filling out this form.)
First name
Middle name
Last name
Street Address
City
Province
Postal Code
Phone
E-mail
Next of Kin/Executor Information
Is there a will?
Is the above person the executor of the will?
Is the above person the legal next of kin?
Please enter the information of the executor below:
First name
Middle name
Last name
Phone
Beneficiary's Information Information: (Person for whom the pre-arranged funeral is for)
First name
Middle name
Last name
Street Address
City
Postal Code
SIN
Date of Birth (please type in year)
City of Birth, Province
Marital Status
Spouse (maiden name)
Occupation for most of working life
Industry
Father's Name (Last, First)
Father's Place of Birth (City, Province)
Mother's Maiden Name (Last, First)
Mother's Place of Birth (City, Province)
Safety Information
Is there a pacemaker or defibrillator present?
Permission granted to remove said device if required?
(Required for cremation by law)
Service Type:
If Cremation would you like to pre-purchase an urn?
What price range for an urn are you comfortable with?
If Burial what price range for a casket are you comfortable with?
Do you currently have cemetery property?
Please specify which cemetery
Would you like a luncheon/reception to follow the service?
Would you like help settling your estate?
Are there any additional services you are considering?
Please specify:
Additional Notes:
Has your family used our services before: (Specify if possible)
FORM 2: Pre-arrangement Form
The prearrangement form is designed for those who wish to pay for our services in advance. If you would like to pre plan for our services but pay for them at the time of need please fill out our At Need Information Sheet above.
Purchaser's Information
Please enter the information of the person who is purchasing our services in advance. The Purchaser and Beneficiary are the same person if you are planning for yourself, if you are purchasing a funeral plan for a spouse or parent then they would be the beneficiary and you would be the purchaser.
Relationship to Beneficiary
First name
Middle name
Last name
Street Address
City
Postal Code
Phone
E-mail
Next of Kin/Executor Information
Is there a will?
In order to make final arrangements we will require the executor's participation and permission.
Is the above person the executor of the will?
Is the above person the legal next of kin?
Please enter the information of the executor below or if no executor please enter the information of the legal next of kin below:
Relationship to Beneficiary
First name
Middle name
Last name
Street Address
City
Postal Code
Phone
E-mail
Beneficiary's Information
This is the person whom the funeral arrangements are being made for. This person may or may not be the same as the purchaser.
First name
Middle name
Last name
Street Address
City
Postal Code
SIN
Date of Birth (please type in year)
City of Birth, Province
Marital Status
Spouse (maiden name)
Occupation for most of working life
Industry
Father's Name (Last, First)
Father's Place of Birth (City, Province)
Mother's Maiden Name (Last, First)
Mother's Place of Birth (City, Province)
Services
Payment Options
Service Type:
If Cremation would you like to pre-purchase an urn?
What price range for an urn are you comfortable with?
If Burial what price range for a casket are you comfortable with?
Do you currently have cemetery property?
Please specify which cemetery
Would you like a luncheon/reception to follow the service?
Would you like help settling your estate?
Are there any additional services you are considering?
Please specify:
Additional Notes:
Has your family used our services before: (Specify if possible)
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Please Note: There are two separate types of forms available for pre-arranging. The prearrangement form is designed for those who wish to pay for our services in advance. It is the second form on this page. If you would like to pre plan for our services but pay for them at the time of need please fill out our At Need Information Sheet directly below please.
