Funeral planning form

 
 

This form helps you to think about all the information that we will ask you when we will talk about your funeral. We suggest you print a copy of it first or, if a printer is not available, we will return a copy to you (in duplicate) for your records.

We also suggest you give a copy to your next-of-kin so that they may acquaint themselves with the details recorded. 

If you would like a funeral director to contact you regarding your pre-arrangement, please indicate this on the form. We respect your privacy, therefore no personal contact from Waimea Richmond Funeral Services will be made unless requested. 

Any field that features a red asterisk (*) next to its title is a required field. If you do not know the answer to any required item, please enter the words "not known" so that the form may be properly submitted. 

If you need help understanding any areas of the form, please feel free to contact us.
 

Personal Information
  Full Name 
  Gender 
  Date of Birth (dd/mm/yy) 
  Place of Birth 
  If Place of Birth is not New Zealand, when did you arrive in New Zealand? 
  Address 
  Suburb and City 
  Occupation 
  Ethnic Group 
  If other, please specify 
 

Living Children
  Birthdate of each daughter 
  Birthdate of each son 
 

Parents
  Mother's full name 
  Mother's full name at birth 
  Mother's occupation 
  Father's full name 
  Father's occupation 
 

Marital Status
  Marital Status 
  If married, please fill in the fields below:
  Spouse's full name 
  Spouse's maiden name 
  Your age at marriage 
  Place of marriage 
 
If previously married, please fill in the fields below:
  Spouse's full name (2) 
  Spouse's maiden name (2) 
  Your age at marriage (2) 
  Place of marriage (2) 
  If there were earlier marriages, please list the above details for each 
 

Funeral preferences
  Place of Service 
  If other, please specify 
  Religious denomination 
  Officiant 
  Musical selections to be played 
  I will supply a CD  yes   no  
  Musical selections to be sung 
  Favourite Bible passages 
  Favourite literature or poems 
  Favourite flowers 
  Favourite flower colours 
  Final disposition 
  If other, please specify 
  Plot owned  yes   no  
  Plot cemetery reference 
 

Next of Kin / Executor
  If a Next of Kin or Executor is available, please include their name and daytime contact details 
 

Pre-Paid Funerals
  I have arranged a Prepaid Funeral with 
  I would like to receive information about Prepaid Funerals  yes   no  
 

Further comments
  Please record any other wishes or preferences that are not explicitly catered for above. 
  Please mail a printed copy of this information to me  yes   no  
 

Contact information

If you would like Waimea Richmond Funeral Services to contact you regarding your pre-arrangement, please fill out your daytime contact details below. No personal contact from Waimea Richmond Funeral Services will be made unless the contact information below is complete; therefore, if you do not desire to speak with a Funeral Director, leave these fields blank.
  Daytime telephone number 
  Email Address 
 

Submit or print the form

Once you have completed all relevant fields, you can either print this form (choose 'Print' from the 'File' menu) or press the 'send' button below to send the form to us. Waimea Richmond Funeral Services respects your privacy; your information is confidential and will not be shared with third parties.

 

 
 

 

  
 

New Zealand Independant Funeral Homes Ltd.Member of the New Zealand
Independant Funeral Homes Ltd.