Full Name of Participant
Name at Birth
Date of Birth
Place of Birth
Number of Years in New Zealand
Usual Occupation/Profession
Doctors Name
Full Name of Father
Father's Occupation (prior to retirement)
Full Name of Mother
Mother's Maiden Name
Mother's Occupation (prior to retirement)
Sons
Daughters
MarriedIn a Civil UnionIn a De Facto RelationshipMarriage or Civil Union DissolvedSpouse/Partner DeceasedSeparated from De Facto PartnerNever in a Legal RelationshipPermanently Separated
Spouse/Partners Name
Age and Date of Birth
Place of Marriage
Your Age at Marriage
Venue for Service
Name of Celebrant or Clergy to Officiate
Family Plot at
New Plot Required Yes Cremation at
Ashes
Casket Type
Flowers for the Casket Natural BunchCasket Spray
Flowers Value and Requirements
Type of Flowers and Colour
Catering YesNo
Numbers for Catering
Catering Requirements
Memorial book YesNo
Donations to
Readings
Hymns
Organist/Musicians
Service sheets to be Printed ColourBlack and WhitePhoto PresentationPersonal PhotoRecording of ServiceLivestream
Name
Address
Phone Numbers
Executor's Name
Executor's Phone number
Lawyer's Name
Do you have a current will YesNo
Do you already have a pre-paid Funeral plan? YesNo
If you do, who with
Who do you bank with
Which Bank Brach do you use
Δ
