Immediate Need Form

Full Name

Please tell us who passed away:

First Name of Deceased*

Middle Name of Deceased*

Last Name Of Deceased*

Last Name at Time of Birth*

Address of Deceased*

Apt, Suite, Etc.*

City*

Province*

Postal Code*

Sex of Deceased Male Female

Where and when did the death occur:

Place of Death*

City*

Year of Death*

Month of Death*

Day of Death*

Person in charge of cremation arrangements: (must be Executor, if no Executor legal next-of-kin)

Full Legal Name*

Relationship to Deceased*

Address of Person in Charge*

Apt, Suite, Etc.*

City*

Province*

Postal Code*

Telephone (Residence)*

Telephone (Mobile)*

Telephone (Work)*

Arranger Email*

Cremation Information:

Did deceased leave a will?*

Yes

No

*If yes, please email a copy of the page of the will that names the executor, copy of the page of the will that shows it was signed and dated and photo ID of the executor to [email protected]. We are not asking for Power of Attorney documents – Power of Attorney stops when the death occurs.

Full Legal Name of Executor*

Is there an objection to cremation by the executor or immediate family?*

Yes

No

If Yes please explain

Did the deceased leave written direction about being cremated?*

Yes

No

If Yes please explain

Did the deceased have a pacemaker?*

Yes

No

Did the deceased receive any radioactive implants?*

Yes

No

Did the deceased have any infectious or contagious diseases?*

Yes

No

Approximate Height of Deceased*

Approximate Weight of Deceased*

Jewelry to be removed?*

Yes

No

If Yes please list all

Who is authorized to pick up cremated remains*

Where would you like to pick up the cremated remains, any one of the following 3 locations are included in our package, if you would like delivery or shipping at an additional fee please speak to your funeral director*

Where would you like to pick up the cremated remains Aftercare Toronto, 1097 O’Connor Drive Aftercare Oshawa, 901 Simcoe Street North (Thursday Appointments) St. John’s Dixie Crematorium, 737 Dundas St E, Mississauga

Information about deceased:

Year of Birth*

Month of Birth*

Day of Birth*

City of birth*

Province of birth*

Country of birth*

Relationship Status Single Married Widowed Divorced Common-Law

First Name of Spouse or Partner*

Middle Name of Spouse or Partner*

Last Name of Spouse or Partner at Birth*

Name of Father of Deceased*

Father of Deceased Place of Birth*

Name of Mother of Deceased*

Mother’S Last Name At Birth*

Mother of Deceased Place of Birth*

Type of work done during most of working life*

Type of business or industry*

Is the deceased eligible for coverage by ODSP or Social Services?*

Yes

No

If Yes please list all

Urn (as chosen from our Merchandise page)¹*

Urn engraving¹*

Yes

No

We offer fingerprint jewelry for purchase – would you like us to take a fingerprint for this purpose?*

Yes

No

Are the cremated remains being taken out of the country?*

Yes

No

How did you hear about Aftercare?*

Location Information

Choose a Location Aftercare Toronto Aftercare Oshawa / Whitby

Additional notes or comments*

Submit

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