Immediate Need | Affordable Cremation & Burial (Vancouver Island)

If A Death Has Just Occurred

Immediate Need Form

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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 (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 (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: