Pre-Arrangement Form

Purchaser's Information

Please enter the information of the person filling out this form.

Relationship to Beneficiary :

Name:      

Street Address:

City:       Postal Code:  

Phone:  Email:  

Next of Kin/Executor Information

Is there a will? Yes No Unsure

In order to make arrangements at the time of need we will require the executor’s participation. If there is no will in place, the legal next of kin will be required to participate in the arrangements. Please enter the information of the executor or, if there is no will, the information of the legal next of kin.

If the purchaser is the executor or next of kin .

Relationship to Beneficary:

Name:      

Street Address:

City:       Postal Code:  

Phone:    Email:  

Beneficiary's Information

Name:      

Street Address:

City:       Postal Code:  

SIN:  

Date of Birth:  City of Birth:

Martial Status: Single Married Widowed Divorced Common-Law Same-Sex Partner  Spouse:

Occupation for most of working life:

Father's Name:             

Father's Place of Birth: 

Mother's Maiden Name:

Mother's Place of Birth:

Services

Cremation Burial Undecided

Would you like to purchase an urn? Yes No

->If yes, what type of urn would you like?:

Would you like help settling your estate? Yes No

Are you interested in the World Travel Plan? Yes No

Are there any additional services you are considering? Yes No

-> If yes, pleace specify:

Additional Notes:

Please enter the security code in the box below:

Click to submit information to BasicCremations.com