Immediate Need | Affordable Cremation & Burial

If A Death Has Just Occurred

Immediate Need Form

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

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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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