Funeral Pre-Arrangement Form
Submit the form below to begin the funeral pre-arrangement process. You can fill in as much or as little as you like. Once submitted, we will be in touch to discuss you arrangements and answer any questions. You also have the option to print this form for your records.
Full Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
This funeral arrangement is for
Myself
Someone esle
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Funeral Details
Funeral Type
Burial
Cremation
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BURIAL DETAILS
Casket Selection
Custom Painted
Yes
No
Viewing
No Viewing
Open Viewing
Family Viewing
Pall Bearers
Flowers for Casket
Existing Plot
Yes
No
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CREMATION DETAILS
Instructions for Ashes
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FUNERAL DETAILS
Venue
Celebrant
Songs/hymns to be sung at service (if any)
Music to be played at service (if any)
Bible readings/poems/literature to be read at service (if any)
Other ideas to make it personal
Refreshments after service
Yes
No
Donations made to
RSA to participate
Yes
No
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Details of Death Certificate
Full legal name
Gender
Male
Female
Date of birth
-
Day
-
Month
Year
Date
Place of birth
Years lived in NZ (if not born in NZ)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Usual occupation (before retirement)
Ethnic group
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Family Details
Please write all your children's names and birthdates below:
Please write them in seperate lines as: Full Name, DD/MM/YYYY (eg. John Smith 1/1/2011)
Mother's full name
Mother's maiden name
Mother's occupation
Father's full name
Father's occupation
Marital status
Please Select
Married
Never married
Partnered/de facto
Widowed
Civil union
Seperated
Marriage dissolved
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Next of Kin Details/Executor of Estate
Full name
Relationship
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact email
example@example.com
Contact phone
-
Area Code
Phone Number
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Lawyer/Solicitor Details
Name
First Name
Last Name
Company name
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Funeral Notices
Wording
Where published
Member of Armed Services
Yes
No
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Additional information
Any additional information we may need to know:
Submit
Should be Empty: