Pre-Planning Form Personal InformationName* First Last Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date of Birth* Place of Birth*AgeYears at current residenceMoved FromEducation (years)Education HistoryOccupationType of IndustryYears employedRetirement Date Social Sec. #SpouseIf deceased (Date) Wife's maiden nameAncestry (nationality)Father's nameMother's maiden nameIf you are a Veteran, please completeBranch of ServiceSerial #RankDate of Entry Place of EntryDate of Discharge Place of DischargeMembershipsPlease 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 & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*CellWorkSocial Sec. #
