Local 905-678-8922 Toll Free 1-833-363-9428
7025 Legion Rd (at Derry Rd.) | Mississauga, ON | L4T 1A8
Pre-Arrange Online
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Personal Information
Address
This Form Completed By
Form Completed by Self
Form Completed by Friend/Relative
Start date must be before end date.
Do You Require A Second Service?
Yes
No
Start date must be before end date.
Do You Require A Third Service?
Yes
No
Start date must be before end date.
Do you Require Interment Details for the Website?
Yes
No
Start date must be before end date.
Do You Require A Second Interment?
Yes
No
Start date must be before end date.
Do You Require A Third Interment?
Yes
No
Start date must be before end date.
Future Service Information Required?
Yes
No
Do you want an announcement for the Future Service?
Yes
No
Pallbearers Information Required?
Yes
No
CPP - Deceased Information Required?
Yes
No
Deceased Different Name at Birth?
Yes
No
Deceased Different Name on Social Insurance Card?
Yes
No
Deceased Live or Work in Another Country?
Yes
No
Add Another Country?
Yes
No
Add Another Country?
Yes
No
Deceased Receive or Apply for a Benefit?
Yes
No
If Yes to Any of the Above, Provide Social Insurance Number
Deceased/Spouse Eligible to Receive Family Allowance/Child Tax Benefit for Any Children Born After December 31, 1958?
Yes
No
CPP - Spouse Information Required?
Yes
No
Home Address Same as Mailing Address?
Yes
No
Address
Spouse Different Name at Birth?
Yes
No
Spouse Different Name on Social Insurance Card?
Yes
No
Spouse Receiving or Applied for a Benefit?
Yes
No
If Yes to Any of the Above, Please Provide Social Insurance Number or Account Number Under Which You Applied
Common-Law Information Required?
Yes
No
Under 45 at Time of Spouse's Death?
Yes
No
CPP - Child(ren) Information Required?
Yes
No
Child(ren) Under 18?
Yes
No
Add a Second Child?
Yes
No
Child(ren) Between 18-25 in Post-Secondary?
Yes
No
Address
Add a Second Child?
Yes
No
Address
Child(ren) Receiving or Applied for a Benefit?
Yes
No
If Yes to Any of the Above, Provide Name and Social Insurance Number for Corresponding Benefit
Child 1
Child 2
Child 3
Child 4
Child(ren) In Your Custody Since Spouse's Death?
Yes
No
Descendant Born After December 31st, 1958?
Yes
No
If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada
Add A Second Child?
Yes
No
If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada
Add A Third Child?
Yes
No
If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada
Add A Fourth Child?
Yes
No
If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada
Were You The Primary Caregiver For These Children From Birth Until Age 7?
Yes
No
Children Under Age 7 and Did Not Receive Family Allowance
Yes
No
Deceased Have a Will?
Yes
No
Additional Purchaser Required?
Yes
No
Additional Purchaser Required?
Yes
No
Service Options
Package Options
Custom Arrangement
Package Options
Traditional service package
$0.00
Same day or memorial service package
$0.00
Home-going service package (use of Chapel)
$0.00
Graveside service package
$0.00
Direct service package
$0.00
Direct ship-out service package
$0.00
Home-Going Service 2hr Package
$0.00
Other Services
Supervision Services
Other Staff
Use of Facilities
Other Facilities
Transfer of Remains to Funeral Home
Vehicle Selection
Other Vehicles
Casket Selection
Other Casket
Vault Selection
Other Vault
Urn Selection
Other Urn
Stationery Options
Additional Services and Merchandise
Other Merchandise
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7025 Legion Rd (at Derry Rd.) | Mississauga, Ontario | L4T 1A8
Local: 905-678-8922 | Toll Free: 1-833-363-9428 | Fax: 905-678-1723 | Email: info@newhavenfc.ca
Funeral Establishment Operator – Class 1
Licence no. 1347