Arrangement Form

Please take a few moments to fill out the arrangement form provided below. While it may be challenging, we ask that you try to provide us with as much information as possible for the Vital Statistics Agency of BC. Doing so will allow us to begin the at-need or pre-need arrangement process and completion of necessary documents.

Once these initial questions have been asked, the funeral director will contact you to further the arrangements. Please know that should you have any questions or concerns; please do not hesitate to contact us.

If someone has passed away, please call us as well as completing the form below.

Arrangement Form

Free Text

Please note that the required Social Insurance Number and Provincial Care Card Number can be provided over the phone, if preferred.

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VITAL STATISTICS INFORMATION

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*Required Fields: must be completed to submit the form. If the information is not known or to be determined, please enter 'unknown' or select from the drop-down menu.

Choose What You Are Planning For:

I am Planning for:

Full Name:

Full Maiden Name

Full Address:

Date of Birth:

Place of Birth:

Date of Death (if applicable):

Facility of Death (if applicable):

Personal Health Number (PHN):

Social Insurance Number (SIN):

Occupation (before retirement):

Business Type:

Marital Status:

Spouse's Name (including Maiden):

Father's Name:

Father's Place of Birth:

Mother's Name (including Maiden):

Mother's Place of Birth:

Type of Service:

Viewing:

Disposition:

Urn Preference:

Casket Preference:

Cemetery Name (if applicable):

Height (approximate):

Weight (approximate):

Jewelry:

Pacemaker:

Communicable Disease:

Nuclear Medicine Recipient:

Would you like to be invited to our Cadence Estate Settlement Program? ($195.00)

Number of Death Certificates ($27):

Were Pre-Arrangements Made?

Memorial Society of BC Member?

Complimentary Online Obituary

Capture Digital Fingerprint?

DNA Sample with Securigene ($450+) https://www.securigene.com/dna-banking/post-mortem-dna-banking-capsule/

Next of Kin / Contact Person:

Relationship:

Is This Person the Executor?

Next of Kin / Contact Person Number:

Next of Kin / Contact Person Email Address:

Next of Kin / Contact Person Full Address:

Notes & Instructions:

Please select one of the options below:

Phone number for follow up: