This form helps you to think about all the information that we will ask you when we will talk about your funeral. We suggest you print a copy of it first or, if a printer is not available, we will return a copy to you (in duplicate) for your records.
We also suggest you give a copy to your next-of-kin so that they may acquaint themselves with the details recorded.
If you would like a funeral director to contact you regarding your pre-arrangement, please indicate this on the form. We respect your privacy, therefore no personal contact from Marsden House Funeral Services will be made unless requested.
Any field that features a red asterisk (*) next to its title is a required field. If you do not know the answer to any required item, please enter the words "not known" so that the form may be properly submitted.
If you need help understanding any areas of the form, please feel free to contact us. |
Personal Information |
| Full Name |
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| Gender |
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| Date of Birth (dd/mm/yy) |
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| Place of Birth |
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| If Place of Birth is not New Zealand, when did you arrive in New Zealand? |
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| Address |
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| Suburb and City |
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| Occupation |
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| Ethnic Group |
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| If other, please specify |
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Living Children |
| Birthdate of each daughter |
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| Birthdate of each son |
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Parents |
| Mother's full name |
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| Mother's full name at birth |
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| Mother's occupation |
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| Father's full name |
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| Father's occupation |
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Marital Status |
| Marital Status |
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| If married, please fill in the fields below: |
| Spouse's full name |
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| Spouse's maiden name |
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| Your age at marriage |
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| Place of marriage |
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If previously married, please fill in the fields below: |
| Spouse's full name (2) |
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| Spouse's maiden name (2) |
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| Your age at marriage (2) |
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| Place of marriage (2) |
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| If there were earlier marriages, please list the above details for each |
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Funeral preferences |
| Place of Service |
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| If other, please specify |
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| Religious denomination |
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| Officiant |
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| Musical selections to be played |
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| I will supply a CD |
yes
no
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| Musical selections to be sung |
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| Favourite Bible passages |
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| Favourite literature or poems |
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| Favourite flowers |
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| Favourite flower colours |
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| Final disposition |
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| If other, please specify |
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| Plot owned |
yes
no
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| Plot cemetery reference |
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Next of Kin / Executor |
| If a Next of Kin or Executor is available, please include their name and daytime contact details |
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Pre-Paid Funerals |
| I have arranged a Prepaid Funeral with |
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| I would like to receive information about Prepaid Funerals |
yes
no
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Further comments |
| Please record any other wishes or preferences that are not explicitly catered for above. |
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| Please mail a printed copy of this information to me |
yes
no
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Contact information
If you would like Marsden House Funeral Services to contact you regarding your pre-arrangement, please fill out your daytime contact details below. No personal contact from Marsden House Funeral Services will be made unless the contact information below is complete; therefore, if you do not desire to speak with a Funeral Director, leave these fields blank. |
| Daytime telephone number |
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| Email Address |
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Submit or print the form
Once you have completed all relevant fields, you can either print this form (choose 'Print' from the 'File' menu) or press the 'send' button below to send the form to us. Marsden House Funeral Services respects your privacy; your information is confidential and will not be shared with third parties. |
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