Funeral Service Registration Logo
  • Funeral Cost Coverage Program

    Principal Applicant must be Canadian Citizen or Permanent Resident living in Halton Region including Waterdown.
  • Principal Applicant:

  •  - -
  • Spouse's Info:

  •  - -
  • Dependent Children: (Unmarried Only)
    *Married children will have to apply separately.

  •  
  • Dependent Parents: (Principal Applicant's Only)
    *Spouse's Parents will have to apply separately.

  •  - -
  •  - -
  • Banking Information

    Please attach Void Cheque to show Bank Name, Account Number, Branch Code and Account Holder Name.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: