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Personal Details
Full Name:
*
Address:
*
Phone:
*
Email:
*
Gender: *
Male
Female
Next of Kin:
Full Name:
*
Address:
*
Phone:
*
Email:
*
Legal Information
Doctor's Full Name:
*
Doctor's Address:
*
Solictor’s Full Name:
*
Firm where Will is lodged:
*
Instructions regarding:
Clothing:
Family to provide
Shroud to be used
Jewellery:
*
Funeral expenses to be sent to:
*
Registration Particulars
Date of Birth:
/
/
Birthplace:
Nationality:
Date of Arrival in New Zealand (if applicable):
Profession/Occupation:
Father’s Full Name:
Father’s Profession/Occupation:
Mother’s Full Name:
Mother’s Profession/Occupation:
Mother’s Maiden Name:
Number of Marriages/De Facto Relationships/Civil Unions:
Partner’s Full Name:
Nature of Relationship:
Marriage
De Facto
Civil Union
Age when Married/De Facto/Civilly Joined:
Number of Children:
Ex-Service Person:
Army
Navy
Airforce
Service No:
Rank:
Regiment:
Wars Served In:
National Benefit or Pension
Please specify:
Funeral Arrangements
Religion:
*
Casket type:
*
Flower arrangements:
*
Donations (in lieu of flowers):
Music/Hymns:
*
Ex-Service Person Tributes:
RSA Tribute
Last Post
Flag
Other
Please specify:
Post-Funeral Arrangements
Burial
Cremation
I wish to be buried at:
New Grave Plot Number:
*
Reopen Grave Name on Headstone:
*
Plot Number:
*
Headstone Design/Wording Instructions:
*
I wish to be cremated at:
*
Instructions for Ashes:
*
Memorial Plaque/Wording Instructions:
*
Minister/Celebrant Contact (If applicable)
Full Name:
Phone:
Email:
People to be Notified
Person’s Name:
Relationship:
Person’s Phone:
Person’s Email:
Remove Last Person
Add Person
Organisations to be Notified
Organisation Name:
Organisation Phone:
Organisation Email:
Organisation Postal Address:
Remove Last Organisation
Add Organisation
