Funeral Preplanning Form - Watersons Funeral Services

Personal Infomation

Full Name*

Full Name at Birth*

Contact Email*

Contact Phone*

Home Address*

Date of Birth

Place of Birth*

Ethnic Group*

Ethnicity*

Descended From NZ Maori*

Born in New Zealand*

Year of Arrival in New Zealand*

Profession/Occupation*

Mother's Full Name*

Mother's Full Name at Birth*

Mother's Occupation/Profession*

Father's Full Name*

Father's Full Name at Birth*

Father's Occupation/Profession*

Marriage and Civil Union Details

Most Recent Relationship Status*

Current Relationship Details

Spouse's Full Name*

Spouse's Full Name at Birth*

Spouse's Date of Birth*

Partner's Sex*

Current Relationship Details

Partner's Full Name*

Partner's Full Name at Birth*

Partner's Date of Birth*

Partner's Sex*

Current Marriage Details

Spouses Full Name*

Surname

Maiden Name

Spouses Date of Birth*

Age of Deceased at Marriage*

Date of Marriage*

Where Married*

Any Previous Marriages?*

Previous Marriage Details

First Marriage

Spouses Full Name*

Surname

Maiden Name

Spouses Date of Birth*

Age of Deceased at Marriage*

Date of Marriage*

Where Married*

More Marriages?*

Second Marriage

Spouses Full Name*

Surname

Maiden Name

Spouses Date of Birth*

Age of Deceased at Marriage*

Date of Marriage*

Where Married*

Add More Marriages?*

Marriage Details*

Please list the spouses full name, surname (maiden name), spouses date of birth, age of deceased at marriage, date of marriage, and where married for all additional marriages not already listed above

Family

Any Children?*

Names and Dates of Birth of Daughters*

Names and Dates of Birth of Sons*

Further Information

Do you hold Awards/Honours?*

What Awards/Honours*

Are you a Marriage or Civil Union Celebrant?*

Are you a Justice of the Peace?*

Did you Serve in the Military?*

Military

Rank*

Service (RSA) Number*

Unit or Regiment*

Overseas New Zealand Service*

Who Should be Informed

Next of Kin/Executor

Name*

Relationship*

Address*

Mobile*

Home Phone

Work Phone

Email Address*

Solicitor or Other Person Holding the Will

Name*

Work Address*

Mobile*

Work Phone

Email Address*

Employer Details

Name*

Mobile*

Work Phone

Email Address*

Attendance

Who Would You Like to Attend*

My Pre-Arrangements

Religion*

Service Venue*

Name of Preferred Celebrant*

Address of Preferred Celebrant*

Funeral Director With Whom Funeral Arrangements Have Been Made*

Has the Funeral Been Prepaid*

Details*

Would You Like to be Buried or Cremated*

Grave Location*

Select an Option*

Plot*

Ashes Placement*

Select and Option*

Plot*

Who Would You Like to be Asked to Speak at Your Funeral?*

Pallbearers Names*

Music/Hymn/Song Preferances*

Special Readings*

Flowers or Donations to*

Any Special Instructions

Clubs and Assosiations

Please Record the Name, Phone Number or other Contact Details and Membership Numbers etc.

Investment Services

Banks*

Investments*

Other

Professionals

Solicitor*

Public Trustee*

Accountant*

Doctor*

Dentist*

Other Medical Specialists*

Registration Board/s (eg. Nursing, Teaching)*

Justice of the Peace*

Services

House Insurance*

Vehicle Insurance*

Medical Insurance*

Life Insurance*

Telephone Services*

Electricity Supplier*

Landlord

Local Authorities

Public Library

Post Office

Motor Vehicle Registry*

Newspaper Delivery

Bank Auto-Payments

Inland Revenue Department*

Other

Work and Income New Zealand

Home Nursing Care

Meals on Wheels

Hire Purchase Companies

Retailer Charge Accounts (e.g. Farmers)

New Zealand Police (Firearms Licensing Section)

Unwanted Mail

Organisations to Contact to Amend Records

Other Notes

Any Additional Notes, Instructions or Requests