Name: Affordable Cremation & Burial - Vancouver Island
Address: 4392 WEST SHORE PARKWAY, LANGFORD, BC, V9B 5Z1
Telephone: 250-391-1540

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.

For further Pre-Need information click here
For further At-Need information click here

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

Vital Statistics Information

Free Text

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

*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:

A Death has Occurred and we require online arrangements

A Death has Occurred and we require in person arrangements *fee

I am planning for the future

I am Planning for:

Myself

A Loved One

Full Name* (including Maiden):

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 (Feet/inches) (approximate):

Weight (lbs) (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 ($498+) 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 Phone Number*:

Next of Kin / Contact Person Email Address:

Next of Kin / Contact Person Full Address*:

Notes & Instructions:

Please select one of the options below:

Please send me information about pre-need arrangements

Please send me information about at-need arrangements

If you are preplanning for yourself or someone else, what is your contact email?

New Paragraph

Having trouble submitting the form?

We're sorry to hear that! Please ensure all fields required fields* are entered, or contact us for assistance.

The Book of Memories

Click here to learn more about complimentary The Book of Memories online tribute page.
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Digital Fingerpints

Click here to learn more about Eternity's Touch unique digital fingerprint mementos.
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Cremation Urns

Click here to learn more about the variety of wood, biodegradable and metal urns we offer for all budgets.
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Cremation & Burial Caskets

Click here to learn more about the variety of cremation & burial caskets we offer for all budgets.
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