For (Full Name):
Email:
Please leave this field empty.
This information is for guidance at such time of my death. Preferences on certain subjects have been expressed, and unless changed by unforeseen circumstances, are desired.
WHEN THE NEED ARISES, I DESIRE that BELL, LAMB AND TROTTER FUNERAL DIRECTORS LIMITED be contacted to conduct all necessary arrangements for my funeral. A copy of my own personal wishes expressed below is held at their office:
Funeral Service to be held at:
Celebrant:
Minister:
Cremation at: Select OneMainland CrematoriumCanterbury CrematoriumHarewood CrematoriumOther
If Other, please specify:
Burial at: Select OneAvonhead ParkBelfastMemorial ParkRuru LawnShands RoadSpringstonYaldhurstOther
Burial Plot No. / Ashes to be interred at:
Notices in Newspapers: Select OneThe PressNew Zealand HeraldDominion PostOtago Daily TimesSouthland TimesOther
Before/After Service: Select OneBeforeAfter
Age in Newspaper: YesNo
Mention of flowers:
Donations to:
Choice of Casket: Select OneHandcrafted Solid TimberRaised LidStandard RimuRosewoodMaple VeneerWalnut VeneerEco CoffinBatesville
Preference of Casket Flowers: Select OneCasket SprayNatural SprayOther
Type/colour:
RSA/Lodge/Clubs/Other Affiliations:
Service Preferences
Music/Hymns/Songs: YesNo
Readings/Poems: YesNo
Catering: Select OneBell, Lamb & TrotterOther
If other, please specify:
Clothing:
Jewellery to remain:
Jewellery to return:
Funeral Account to:
Name:
Address:
Prepaid: YesNo
Amount:
Date:
Further details I would like observed:
Personal:
Profession/Occupation:
Date and place of birth:
If born overseas: I have resided in New Zealand since
Service Record: Service No:
Rank:
Regiment:
Wartime Service:
I am a Justice of the Peace, Registered Nurse or Title holder of:
Next of Kin:
Trustee/Executor:
Parents:
Father's Full Name:
Father's Occupation:
Mother's Full Maiden Name:
Mother's Occupation:
Mother's Marital Status: Select OneMarriedDivorcedSeparatedUnmarriedWidowed
Marriage:
Spouse's Full Name (Maiden):
Spouse's Date of Birth:
Date and Place of Marriage:
Previous Marriage Details:
Children:
First Name and Date of Birth of Living Children:
Other personal details:
My Will is held by:
Solicitor:
Society/Club Memberships: