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PRE-ARRANGEMENTS
Client Profile
Client Profile
To help your family make arrangements
please complete any of the following fields:
Name:*
Address:
My next of kin is:
Date of birth:
I would like to be embalmed:
I would like to be viewed:
at:
I would like to be:
I would like to buried at:
Or I would like my ashes to be:
Plot (if applicable):
The style of casket I would like is:
My place of birth:
My nationality:
I would like notices placed in the following papers:
Others:
King Country News
NZ Herald
Waikato Times
Children
Name and Date of Birth of each daughter (please include any deceased children and age when died)
Name and Date of Birth of each son (please include any deceased children and age when died)
Parents
Mother's full name:
Mother's full name at birth:
First or Given Names
Surname or Family Name
Father's full name:
Father's full name at birth:
First or Given Names
Surname or Family Name
I would like:
Flowers on my casket:
Committal flowers/petals:
Service sheets/bookmarks:
Memorial book at the service:
Reflection DVD/Slideshow during my service:
Photo board:
Piper:
I would like the following music, hymns, readings and/or poems at my funeral:
I would like the following pallbearers:
I would like donations to be made to:
Other instructions: e.g. refreshments after the service or information for eulogy
Marital Status:
Most recent Relationship
To Whom Married (including Maiden Name):
Age of living partner:
Age Dec'd at marriage:
Where Married:
Previous Relationship
To Whom Married (including Maiden Name):
Age of living partner:
Age Dec'd at marriage:
Where Married:
Previous Relationship
To Whom Married (including Maiden Name):
Age of living partner:
Age Dec'd at marriage:
Where Married:
To receive a copy of this filled form please provide your email address:
Date
.
Your content has been submitted. We will get back to you as soon as possible.
Please fill in the input field(s) highlighted in red before submitting.
Headstone Details
Name of contact:*
Contact telephone number:
Email of contact:*
Contact mailing address:
Name on monument:*
Date of birth:*
Date of death:*
Photo:
Vases:
Dates to be numerical or words:
Shape of plate:
(choose from the pamphlet, display room or photographs
Shape of base:
(regular rectangle, bevelled centre, desk or other)
Family names to be included:
Interests, hobbies or groups enjoyed for a picture:
(flowers, pets, sports etc)
Cultural or religious symbols:
Colour of the plate:
Colour of base:
To be installed at:
(Name of cemetery or urupa if we are to install.
Otherwise put ‘supply only’)
By:
Quotes:
(unveiling date)
To receive a copy of this filled form please provide your email address:
by:
by:
Your content has been submitted. We will get back to you as soon as possible.
Please fill in the input field(s) highlighted in red before submitting.
Headstone Details
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