Pre-Arrange Online

  • Personal Information

Address

This Form Completed By

Spouse's Information

Spouse's Address

Father & Mother Information
Work
Funeral Service Information
Disposition Information

Is/Are there Executor(s)

More Executors?

Additional Information
Special Instructions

Please list any other instructions or information you would like us to have

Send Information
For Office Use Only

Office Staff Only

Funeral Home Information

Additional Deceased Information
Informant

Do You Require a Second Informant

Do You Require a Third Informant

Additional Disposition Information

Burial Information Required?

Service Type
Physician
Survivor
Survivor
Survivor
Survivor
Visitation Information
GPS Coordinates (Optional)

Do You Require A Second Visitation?

GPS Coordinates (Optional)

Do You Require A Third Visitation?

GPS Coordinates (Optional)
Service Details
GPS Coordinates (Optional)

Do You Require A Second Service?

GPS Coordinates (Optional)

Do You Require A Third Service?

GPS Coordinates (Optional)
Interment Details

Do you Require Interment Details for the Website?

GPS Coordinates (Optional)

Do You Require A Second Interment?

GPS Coordinates (Optional)

Do You Require A Third Interment?

GPS Coordinates (Optional)
Future Services

Future Service Information Required?

Do you want an announcement for the Future Service?

Clergy / Minister
Church Requirements
Charity Selection
Service Clubs
Pallbearer Information

Pallbearers Information Required?

Pallbearer
Pallbearer
Pallbearer
Pallbearer
Pallbearer
CPP - Deceased Information

CPP - Deceased Information Required?

Deceased Different Name at Birth?

Deceased Different Name on Social Insurance Card?

Deceased Live or Work in Another Country?

Add Another Country?

Add Another Country?

Deceased Receive or Apply for a Benefit?

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?

CPP - Spouse Information

CPP - Spouse Information Required?

Home Address Same as Mailing Address?

Address

Spouse Different Name at Birth?

Spouse Different Name on Social Insurance Card?

Spouse Receiving or Applied for a Benefit?

If Yes to Any of the Above, Please Provide Social Insurance Number or Account Number Under Which You Applied

Common-Law Information Required?

Under 45 at Time of Spouse's Death?

Child(ren) Information

CPP - Child(ren) Information Required?

Child(ren) Under 18?

Add a Second Child?

Child(ren) Between 18-25 in Post-Secondary?

Address

Add a Second Child?

Address

Child(ren) Receiving or Applied for a Benefit?

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?

Descendant Born After December 31st, 1958?