Prearrangement Form

Click here to download the PDF version of the
Prearranged Funeral Form. Once you've printed
it out and filled it in, follow the instructions on the
last page

(if you don't have adobe reader, please click here)

First Name(s)*
Surname*
Maiden Name
Phone Number/s*
Email Address
Usual Home Address
Date of Birth
Place of Birth
If not born in NZ, year of arrival
Occupation
Legal marital status
Holder of an Honour or Award?
Social security benefit holder?
Children Living?
Mother's Name
Mother's Maiden Name
Mother's Occupation
Father's Name
Father's Occupation
First Marriage to Whom
Surname at time of Marriage
Your age at time of Marriage
Spouse's date of birth (if living)
Where married
Second Marriage to whom
Surname at time of Marriage (2)
Your age at time of Marriage (2)
Spouse's date of birth (if living) (2)
Where married (2)
If there were more, enter here
Birth Dates of Sons
Birth Dates of Daughters
Name of Minister, Priest or Celebrant to be advised who will officiate at my funeral service
Name and address of next of kin/ Executor who is expected to make funeral arrangements
I'd like my funeral service held at
Other
I want to be
Specific Method
I wish to be interred/cremated at
Specific Place
I have this burial/ashes plot
Name and address of Solicitor
I'd like the following hymns/music
Readings
Tributes by
Club, organisations, lodges or societies I belong to
People who should be notified at time of death and contact details
Instructions regarding flowers
Pall bearers
Death notices to be inserted into the following papers
Any other special requests or instructions
Regimental or service number
Service
    
Which war/s?
Rank
Regiment/unit
Service decorations
Any ritual, last post, ode, flag etc?
My prepaid funeral plan number is