PRE-ARRANGEMENT FORM

The fields marked * are required to be entered.

Personal Details:

Family name: * First name(s): *
Name at Birth ( if different from above )
Date of Birth: No of years in NZ:
Place of Birth:    
   
Street Address: City:
 
Phone: *   Email: *
 
Usual Occupation ( before retirement )
Ethnic Group   Maori Descent
 
Civil Honours ( eg. J.P. OBE etc)

Next of Kin Details:


Full Name:
Street Address:   City:
 


Family information required by Registrar of Births, Deaths & Marriages

Children Details:


Sons dates of birth:
Daughters dates of birth:

Parent Details:


Fathers name:   Mothers name:
Fathers birth name ( if different )   Mothers Maiden name:
 
Occupation:   Occupation:
 

Your Marriage Details:


Married

Never Married
Widowed

 

Permanently Separated
Marriage Dissolved

 

Partnered or Defacto
 

If currently married

To Whom Married ( if wife include maiden name )::
Spouses date of Birth Your age at Marriage
 
Place of Marriage  
Previous Marriage (1)
To Whom Married ( if wife include maiden name )::
Spouses date of Birth Your age at Marriage
 
Place of Marriage  
Previous Marriage (2)
To Whom Married ( if wife include maiden name )::
Spouses date of Birth Your age at Marriage
 
Place of Marriage  

Funeral Details:


Burial

Cremation
Place of burial ( if applicable )
Ashes to be placed / scattered at ( if applicable )
Furneral Service at:
Church

Funeral Home Chapel
Home

 

Other Location
Service to be conducted by
Details of service and any special instructions
( include Hymns, Songs, Readings, Flowers, Casket etc )

Other Important Details:


Name of Family Doctor
Address of Family Doctor  
Name of Solicitor  
Address of Solicitor  
Name of Executor(s)  
Date of Last Will  
Will Held By  


Additional information you would like us to be aware of:





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