Pre Arrangement Form

You can record as much or as little information as you feel comfortable with. All records kept at our office are confidential.

If we can be of further assistance or you have any other questions,

Please do not hesitate to contact us at:
Whakatane (07) 307 1111 or Opotiki (07) 3158 888

Your Details
Next of Kin details
Parents Details
Relationship Details
Personal Wishes

Your Details

Full Name

Also known as?

Maiden Name

Address

Phone Number

Email Address

Gender

Date of Birth

Place of Birth

Country of Birth

If place of birth is not NZ, what year did you arrive in NZ:

Usual Occupation

Ethnic Group

Are you a Justice of the Peace or Marriage Celebrant?

Member of Lodge or Association

Were you a member of the Armed Services? (Please enter service number, rank, regiment and unit below)

Next of Kin

Next of Kin Name

Next of Kin's relationship to you

Next of Kin's Phone Number

Next of Kin's Address

Parents Details

Father's full name

Father's occupation

Mother's full name

Mother's maiden name

Mother's occupation:

1st Marriage (Most recent)

Current Status

Spouse's full name

Spouse's maiden name

Spouse's Gender

Your age at marriage

Place of marriage

Spouse's Date of Birth (If Living)

2nd Marriage

Current Status

Spouse's full name

Spouse's maiden name

Spouse's Gender

Your age at marriage

Place of marriage

Spouse's Date of Birth (If Living)

3rd Marriage

Current Status

Spouse's full name

Spouse's maiden name

Spouse's Gender

Your age at marriage

Place of marriage

Spouse's Date of Birth (If Living)

Children's Details

Daughter's Names and Dates of birth

Son's Names and Dates of birth

Personal Wishes

Where would you like the service held?

Who would you like to take the service - Celebrant / Minister / Priest?

In which newspaper/s would you like the notice placed?

In lieu of flowers, I would like donations to be made to?

Colour, type or preference for casket flowers?

Is there a piece of music or hymn you would like?

Cremation

Is your wish to be cremated? (if no please move onto the next burial questions)

Would you like your ashes to be interred or scattered?

And who would you like to Inter or scatter your ashes?

Burial

Is your wish to be buried?

Special Requests

Do you have any special requests?

Pre Arrangement Form

You can record as much or as little information as you feel comfortable with. All records kept at our office are confidential.

Our Commitment to you

Important Page

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