Language
English (UK)
Taking Care of Your Wishes
Please give us as much information as possible and fill in all relevant fields.
About You
Name
*
Mr.
Mrs.
Ms.
Dr.
Prof.
Title
First Name
Surname
Address
*
Street Address
Street Address Line 2
City
County
Postcode
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Date of Birth
-
Day
-
Month
Year
Date
Next of kin
Name
*
Mr.
Mrs.
Ms.
Dr.
Prof.
Title
First Name
Surname
Address
Street Address
Street Address Line 2
City
County
Postcode
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Relationship to you
*
The Funeral
I would like to be buried:
I have an existing lair
I would like a new lair
If you have an existing lair, please let us know the location & lair number:
If you would like a new lair please let us know the location required:
I would like to be cremated and would like my ashes to be:
Returned to my family
Scattered at the crematorium
Interred at (please specify below)
Other (please specify below)
Where would you like your ashes interred or what 'other' option would you like:
Preference for coffin or casket:
Traditional Wood Veneer
Simple Wood Veneer
Wicker
Cardboard
Other (please specify below)
Please let us know your preference on 'other' coffin or casket:
Before The Funeral
What would you like to be wearing?
What should happen to any jewellery worn at the time of death?
Transport:
Traditional hearse
Other (please specify below)
What type of 'other' transport would you like?
Limousine for family - please specify how many:
The Service
I would like the service to be:
Religious
Non-religious
To be held at:
To be led by:
Readings from scripture:
Other readings/poems:
Entry music:
Service music or hymns:
Exit music:
Flowers:
Flowers
Family flowers only
No flowers
Donation to charity in lieu of flowers
Preferred charity:
Funeral Teas
Would you like Funeral Teas?
Yes
No
Preferred venue:
Catering/refreshments:
Dress code:
Formal
Casual
Any special requests?
Finance and Legal
(Please only give details if you are happy to do so)
Do you have a pre-paid funeral plan?
No
Yes
If yes, please give us details of the pre-paid company name and plan number:
Do you have a will?
No
Yes
If yes, please give us details of the executors and where the will is kept:
Any other details you want to record that are not covered in the questions above?
Personal Notes
Please fill in any additional notes you would like to record:
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