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
Spouse/Partners Name Place of Marriage Your Age at Marriage Spouse/Partners Name Place of Marriage Your Age at Marriage Spouse/Partners Name Place of Marriage Your Age at Marriage Spouse/Partners Name 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
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