Pre Arrangement Form

We understand how difficult it is to lose a loved one. While the days ahead may be challenging, our compassionate and experienced team are here to support you every step of the way, making the arrangement process as simple and stress-free as possible.

Whether you are planning for the future or a death has taken place, we ask that you take a few moments to complete the online arrangement form below. Providing as much information as possible will assist us in preparing the required documents for the Vital Statistics Agency of BC and will allow us to better honor your loved one.

Pre-Arrangement Form

Free Text

Please note that the required Social Insurance Number and Personal Health Care Card Number can be provided over the phone, if preferred.

Free Text

VITAL STATISTICS INFORMATION

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*Required Fields (marked by an asterisk *) must be completed to submit the form.

If the information is not known or to be determined, please enter 'unknown' or select from the drop-down menu.

When will our services be required?

I am Planning for

Full Given Name (including Maiden):

Full Address (Street Address, City, Province, Postal Code):

Phone Number:

Email Address:

Date of Birth:

Place of Birth:

Date of Death (if applicable):

Place of Death (if applicable):

Where is your loved one located? (if applicable):

Coroner's case number (if applicable):

Physician's Name:

Personal Health Number (PHN):

Social Insurance Number (SIN):

Upload Identification: (Only 1 of the following is requested-Drivers license, Care Card, Passport, Birth Certificate, BC Services Card, Citizenship Card)

Upload File

Marital Status:

Spouse's Name including Maiden (Enter N/A only if Never Married):

Occupation (when actively working):

Business Type:

Number of Years Worked:

Father's Name:

Father's Place of Birth:

Mother's Name (including Maiden):

Mother's Place of Birth:

Disposition:

Casket Preference:

Number of Death Certificates ($27 each):

Cemetery (if applicable):

Height (approximate):

Weight (approximate):

Urn Preference:

Pacemaker:

Communicable Disease:

If yes, specify (Communicable Disease):

Nuclear Therapy Recipient:

Jewelry Removal:

Eternity's Touch' Fingerprint Capture:

Memorial Society Member:

Memorial Society Membership Number:

Were Pre Arrangements Made?:

Aboriginal Status:

Is there a Will?:

Next of Kin / Contact Person Full Name:

Relationship:

Is this Person the Executor?:

Next of Kin / Contact Person Phone Number

Next of Kin / Contact Person Email Address:

Next of Kin / Contact Person Full Address

Would you like us to create an online obituary page?

Would you like to be invited to our Aftercare program offering estate guidance and support?

Please select one of the options below:

Miscellaneous Notes and Instructions:

Get in Touch

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