| Your Contact Information |
Email Address*:
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Confirm Email Address:
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| Your Personal Information |
Last name*
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First and middle names*
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Date of birth (yyyy/mm/dd)
Birthplace
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Social Insurance Number
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Street (911) Address
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Mailing Address
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Zip or postal code
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Phone number (include area code)
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Type of work done most of working life (e.g. teacher)
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Type of business or industry (e.g. Education)
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Membership in fraternal, civic, or professional organizations (e.g. Legion, Rotary, Masonic Lodge)
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Church affiliation and activities (e.g. United, UCW)
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Did you serve in the military?
Yes
No
If Yes, in which war(s) or conflict(s) did you serve?
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Other special events or activities
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Your Parents |
Father's name
Father's birthplace (city, province)
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Mother's maiden name
Mother's birthplace (city, province)
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Your Spouse |
Spouse's maiden name
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Date of marriage
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Your Children and Grandchildren |
1. Child's name (first and last)
1. Child's spouse (first and last)
1. Child's address (city, province)
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2. Child's name (first and last)
2. Child's spouse (first and last)
2. Child's address (city, province)
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3. Child's name (first and last)
3. Child's spouse (first and last)
3. Child's address (city, province)
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4. Child's name (first and last)
4. Child's spouse (first and last)
4. Child's address (city, province)
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Number of grandchildren
First names of grandchildren
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Number of great grandchildren
First names of great grandchildren
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Your Siblings |
1. Sibling's name
1. Sibling's spouse
1. Sibling's address (city, province)
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2. Sibling's name
2. Sibling's spouse
2. Sibling's address (city, province)
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3. Sibling's name
3. Sibling's spouse
3. Sibling's address (city, province)
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4. Sibling's name
4. Sibling's spouse
4. Sibling's address (city, province)
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Predeceased by
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Your Funeral Preferences |
Funeral Home
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Funeral Director
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Service to be held at (i.e. Funeral Home chapel, Church, other)
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Clergy or officiant
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Readings and music
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Pallbearers (normally six would be acceptable)
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Organist
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Alternate pallbearer(s)
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I prefer the following clothing/jewellery
Eye glasses?
Yes
No
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Expressions of sympathy
Flowers
Donations
Wishes of survivors
Donations to:
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Your Interment Preferences |
I prefer
Burial
Cremation
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Cremation Urn
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Casket
Metal
Hard Wood
Other
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Other enclosure
Metal
Concrete
Other
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Cemetery/Crematorium
Location (city and province/state, country if not Canada)
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Prearranged burial plot (grave no., plot, section, block, name deed held by)
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Payment Options |
Please choose a preplanning payment option
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