Pre-Planning Form Personal InformationName* First Last Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date of Birth* DD slash MM slash YYYY Place of Birth* AgeYears at current residenceMoved From Education (years) Education History Occupation Type of Industry Years employedRetirement Date MM slash DD slash YYYY Social Sec. # Spouse If deceased (Date) MM slash DD slash YYYY Wife's maiden name Ancestry (nationality) Father's name Mother's maiden name If you are a Veteran, please completeBranch of Service Serial # Rank Date of Entry MM slash DD slash YYYY Place of Entry Date of Discharge MM slash DD slash YYYY Place of Discharge MembershipsPlease list memberships. Examples: Church, Fraternal, Civic, Etc.SurvivorsPlease list names, relationship and residence.Service InformationWhere would you prefer that your service be held? Where is your cemetery property? Musical PreferencesPallbearersMemorial ContributionsResponsible Party InformationName* First Last Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*CellWorkSocial Sec. # CAPTCHA Δ
