Pre-Planning On-Line Form

We are pleased to provide this easy and confidential method for you to begin the planning process.

Using this form, you can record and submit your preferences for your funeral.

Please provide as much information as possible. If there is information you can not supply now, we will work together to obtain or develop the information.

Upon receipt of your submitted form, we will contact you to discuss your plans and options.

* indicates information that is required to submit this form.

All information will be kept strictly confidential.
Your Family Information
Full Name: *
(Include all given names)
 
Social Insurance #:
(Required for Government documents)
Street Address:
City / Town:
Province / State:  
Country:      
Postal / Zip Code:
 
Telephone:
 (xxx-xxx-xxxx)
Fax:
(xxx-xxx-xxxx)
E-mail Address: *
 (name@isp.com)
 
Place of Birth:
(City, Province, Country)
Date of Birth:
 
Occupation:
(Primary form of employment)
Employer, Type of Industry:
Community Involvement:
(List Club Memberships, Fraternal Organizations, etc.)
 

Marital Status:

Full Name of Spouse / Partner:
(Include all given names)

 
Next of Kin
  
   
Father's Full Name:
His Birthplace:
 
Mother's Full Maiden Name:
Her Birthplace:
   
Your Funeral Preferences
  
Location of Service:
Choice for Final Disposition:
Do you own a Cemetery Plot:
Yes No
If Yes -
Name and Address of Cemetery:
Casket / Container Preference:
Outer Case for Cemetery:
Cremation Urn Preference:
Disposition of Cremated Remains:
Visitation:
 
Please list the newspapers where you wish death notices to be published:
 

Please specify the charity(ies) to which memorial donations can be directed to:
 
Would you prefer to prepay the funeral arrangements in order to offset any increase in cost of the Funeral Services and Merchandise?
Yes No
 
   

I understand that while not legally binding to my heirs/executor, the above represents my personal wishes for my funeral plans.

I further understand that if I wish to alter these arrangements, the funeral home will produce the documents upon my request.

Dated:

 

If you have any questions, please do not hesitate to call us at 613-722-1002.

Updated: November 10, 2007

 
     
 
Tubman Funeral Homes
And Cremation
Telephone: (613) 722-6559
info@tubmanfuneralhomes.com

Cadieux Tubman Funeral Homes
And Crematorium
Telephone: (819) 663-8383
info@cadieuxtubman.com

 
     

© 2003 - 2008 - J. A. Tubman Funeral Services Inc.