New Arrangement Form
This section is used when the applicant (insured) is also the owner of the policy OR application is being filled up by the policy owner.
For whom are you making arrangements?
Myself
Someone else (parent or spouse)
About You
Name
*
First Name
Middle Name
Last Name
Address
Unit or House #
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
How did you find out about Alternatives?
Please Select
Friends/Family
Ads
Social Media
Internet
Others
Did anyone in our team assist you?
Name of Enroller
Email of Enroller
*
example@example.com
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About the Applicant
The applicant is the person whom you are making the prearrangements for. Please use their full legal name as it appears on government identification, such as a driver's license, birth certificate, or passport.
Name
First Name
Middle Name
Last Name
Where does Applicant normally live (i.e. their residential address)?
same address as mine
Other
Address
Unit or House #
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your relationship to the Applicant?
Please Select
parent
spouse
child
Applicant's Email
example@example.com
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Vital Statistics
Once a person passes away in British Columbia, the death is registered with the Vital Statistics Agency. As part of this process, we are required to provide the following information. As this is a prearrangement, most of the information in this form are optional. If any information is unknown, please enter "UNKNOWN".
Birth date
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Marital Status
Please Select
Single
Married
Divorced
Widowed
Separated
Spouse's Name
Spouse's First Name
Spouse's Middle Name
Spouse's MAIDEN Last Name
How many years did the applicant work during their lifetime?
What is the latest occupation of the applicant?
In what industry was this occupation?
Birth Place
If any information is unknown, please enter "UNKNOWN".
City of Birth
Province or State
Country
Parents
Please provide full name and birthplace for father and mother. If any information is unknown, please enter "UNKNOWN".
Father's Name
Father's First Name
Father's Middle Name
Father's Last Name
Father's City of Birth
Province or State of Birth
Country
Mother's Name
Mother's First Name
Mother's Middle Name
Mother's MAIDEN Last Name
Mother's City of Birth
Province or State of Birth
Country
Beneficiary Contact
(For excess proceeds)
Name of Beneficiary
First Name
Last Name
Relationship of Beneficiary to the Applicant?
Please Select
parent
spouse
child
Others
If others, please specify.
Beneficiary's Telephone Number
Please enter a valid phone number.
Beneficiary's Email
example@example.com
Beneficiary's Address
Unit or House #
Street Address Line 2
City
State / Province
Postal / Zip Code
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