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

Apt, Suite, Etc.

City

State

Zip 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 Name

Address

Apt, Suite, Etc.

City

State

Zip Code

Telephone

Telephone

Telephone

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 Name

Address

Apt, Suite, Etc.

City

State

Zip Code

Telephone

Telephone

Telephone

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 of Deceased

Country of birth of Deceased

Last Spouse/Partner Full Legal Name

Last Spouse/Partner Last Name At Birth

Relationship Status of Deceased Relationship Status Single Married Widowed Divorced Common-Law

Dec - Type of work done during most of working life

Dec - Type of business or industry

Dec - 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)

Urn engraving¹*

Yes

No

How did you hear about Aftercare?

Location Information

Location Choose a Location Aftercare Toronto Aftercare Oshawa / Whitby

Additional Notes or Comments

Submit

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