Pre-planning   

The following information will help you pre-plan a funeral arrangement and will also provide the necessary details required for the official Death Certificate.

Any field with an asterisk (*) denotes a compulsory entry. If you do not know the answer, please enter the words "not known".

We recommend you print a copy of these details for your records and also supply a copy to your nominated person in charge of the funeral arrangements. If a printer is not available, we are able to send you 2 copies upon request.

If you would like a funeral director to contact you regarding your pre-arrangement, or you wish to be posted out copies of your recorded details, please indicate this on the form. In respect of your privacy, no personal contact will be made from Capital City Funeral Services unless requested.

If you need any help completing this form or have any questions, please feel free to contact us.

Personal Information:

Full Name*:

Gender*:

Date of Birth (dd/mm/yy)*:

Place of Birth*:

If Place of Birth is not New Zealand, when did you arrive in New Zealand?:


Street Address*:

Suburb & City*:

Occupation*:

Ethnic group:

If other selected above, please specify:

Children:

Birthdate of each daughter:

Birthdate of each son:

Parents:

Mother's full name*:

Mother's full name at birth*:

Mother's occupation:

Father's full name*:

Father's occupation:

Relationship Status:

Marital status*:

If married, please complete the fields below:

Spouse's full name:

Spouse's maiden name:

Your age at marriage:

Place of marriage:

If previously married, please complete the fields below:

Spouse's full name (2):

Spouse's maiden name (2):

Your age at marriage (2):

Place of marriage (2):


If there were earlier marriages, please list the above deails for each:

Additional Information:

Are you a Marriage Celebrant or Justice of the Peace? If so, please specify:

Do you hold an Honour or Award? If so, please specify (do not include military decorations):

Funeral Service Requests:

Final disposition:

If other, please specify:

Cemetery or Crematorium:

If other, please specify:

Viewing at:

Viewing address:

Family service at:


Funeral service at:


Officiant/Minister conducting Funeral Service:


Person to be in charge of Funeral arrangements:


Details of Funeral Service and any other special requirements i.e. Casket flowers, Order of Service Sheets, Memorial book, Casket, Newspaper Notice etc:

Would you like us to mail a copy of these details to you? If Yes, please enter Name and Address:

Would you like to be contacted regarding your pre-arrangement? If Yes, please enter Name and Contact details: