Pre-Need Form

Please tell us who these pre-arrangements are for:

Last name of the person for whom these arrangements are for*

First name of the person for whom these arrangements are for*

Middle name of the person for whom these arrangements are for*

Last name at birth of the person for whom these arrangements are for*

Address of person for whom these arrangements are for*

Apt, Suite, Etc.*

City*

Province*

Postal Code*

Has someone already passed away?*

Yes

No

If death is imminent, where is the death expected to occur:

Place of Death*

City*

Person making pre-arrangements:

Relationship to the person for whom these arrangements are for*

Full Legal Name*

Address*

Apt, Suite, Etc.*

City*

Province*

Postal Code*

Telephone (Residence)*

Telephone (Mobile)*

Telephone (Work)*

Arranger Email*

Person who will be signing the paperwork at the time of death: (Must Be Executor, If No Executor Legal Next-Of-Kin)

Relationship to the person for whom these arrangements are for*

Full Legal Name*

Address*

Apt, Suite, Etc.*

City*

Province*

Postal Code*

Telephone (Residence)*

Telephone (Mobile)*

Telephone (Work)*

Arranger Email*

Cremation Information:

Does the person for whom these arrangements are for have a will? We are not asking for Power of Attorney documents – Power of Attorney stops when the death occurs.*

Yes

No

Full Legal Name of Executor*

Approximate Height Of Person For Whom These Arrangements Are For*

Approximate Weight Of Person For Whom These Arrangements Are For*

Information about the person for whom pre-arrangements are for:

Gender*

Female

Male

Year of Birth*

Month of Birth*

Day of Birth*

City of birth*

Province of birth*

Country of birth*

Last Spouse/Partner Full Legal Name*

Last Spouse/Partner Last Name At Birth*

Relationship Status Single Married Widowed Divorced Common-Law

Type of work done during most of working life*

Type of business or industry*

Father's full legal name*

Mother’S Full Legal Name*

Mother’S Last Name At Birth*

Father's City of birth*

Father's Province of birth*

Father's Country of birth*

Mother's City of birth*

Mother's Province of birth*

Mother's Country of birth*

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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