Pre-Planning Form

Personal Details

Family name*

First name(s)*

Street Address*

City*

Birth Place*

Birth Date*

Email*

Years in NZ*

Ethnic Group* Select OneNZ MaoriNZ EuropeanSamoanTonganCook Island MaoriIndianNiueanAustralianEnglishIrishOther European

Descendant from Maori* If applicable select oneYesNo

Venue of Funeral

Venue of Funeral: Select OneChurchChapelOwn HomeOther

If other, please specify:

Name of place

Street Address

City

Who will Officiate

Name

Phone

Second Choice

Phone

Burial / Cremation

Burial Location

Plot Details

Wishes regarding Ashes

Scattered Where

Placed Where

Special Request for Service

Hymns

Music

Choice of Readings

Name of Readers

Flowers family spray

Donations, in lieu of flowers, to

Organisations to be notified

Pallbearers

Name 1

Name 2

Name 3

Name 4

Name 5

Name 6

People to be Contacted

Name

Phone

Street Address

City

Parental Information

Name of Father

Occupation

Name of Mother

Maiden Name

Occupation

Marriage/Civil Union Details

 Married

 Civil Union

 Defacto

Marriage/Civil Union Details 1

To Whom

Place of Marriage/Civil Union

Age

Other

Marriage/Civil Union Details 2

To Whom

Place of Marriage/Civil Union

Age

Other

Marriage/Civil Union Details 3

To Whom

Place of Marriage/Civil Union

Age

Other

Birth Dates of Living Spouse & Children

Spouse

Sons

Daughters

If you are one of the following, please check box

 JP

 Marriage Celebrant

Please name Honours & Awards

Internal Affairs - War Service

Reg Number

Rank

Where served

Years served

General Information

Solicitor

Name

Company

Street Address

City

Phone

Will held at

Birth, Marriage Certificate Kept