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Recording Your Choices

FIND A FUNERAL DIRECTOR
PRE-PLAN AN ECO FUNERAL
RECORD YOUR ECO CHOICES

Recording Your Choices

As part of your planning, you may also like to fill in the personalised planning form. The form can be completed on-line and submitted, or printed so you can add it to your funeral pack.

We are able to keep your details on file for when they are required – you will just have to make sure that your family and close friends know about it. It is a good idea to keep a copy with your will.

The first part of this form, My Personal Details, enables you to record personal information required by the Registrar-General of Births, Death and Marriages. The second part, My Funeral Details, helps you to record your preferences for the funeral arrangements.

Please enter your details – it will be helpful to those arranging the funeral when the time comes.

1My Personal Details

2My Marriage/ Civil Union Details

3My Family Details

4My Funeral Details

MY PERSONAL DETAILS:
Choose One:
- Mr
- Mrs
- Ms
- Miss
- Dr
Surname:*
First Names:*
Name at birth:
Address:*
Email:*
Phone:*
Mobile:
Date of birth:*
DD slash MM slash YYYY
Place of birth:*
Are you descended from NZ Maori?:*
- Yes
- No
- Don't Know
Ethnicity:
If not born in NZ, what was your date of arrival in NZ:
Profession/ Occupation:
Full name of father:
Occupation of father:
Full maiden name of mother:
Occupation of mother
Do you hold an award/ honours (not military):*
- Yes
- No
Title:

MY MARRIAGE/ CIVIL UNION DETAILS:
Your situation:*
- Married
- Civil union
- Divorced
- De Facto
- Widowed
- Separated
- Never married
Most current marriage/ union details:
Your age at the time:
Full name of spouse/ partner at birth:
Place of marriage/ union:
Spouse/ partner's birth date:
Previous relationship details:
Your age at the time:
Full name of spouse/ partner at birth:
Place of marriage/ union:
If living, spouse/ partner's birth date:

MY FAMILY DETAILS:
If living, son/s birth date/s:
If living, daughter/s birth date/s:
Are you a Justice of the Peace:*
- Yes
- No
Are you a Marriage Celebrant:*
- Yes
- No
MY SERVICE RECORD:
Service number:
Overseas/ New Zealand service details:
Which war:
Rank:
Unit/ Regiment:

MY FUNERAL SERVICE:
Name of kin/ executor making the arrangements:*
Address:
Phone:
Mobile:
Name of Solicitor/ person holding will:
Address:
Phone:
Mobile:
Name of Employer:
Name of Doctor:
Name of Funeral Director:
Is the funeral pre-arranged:*
- Yes
- No
Pre-paid:*
- Yes
- No
Preferred Priest/ Clergy/ Celebrant:
Venue of service:
Casket choice (if known):
Choose One:*
- Burial
- Cremation
Plot:
- None
- New
- Single
- Double
- Re-open
Ashes Placement:
- Scatter
- Interment
Cemetery/ Crematorium:
Flowers preferred:
In lieu of flowers, donations to:
Who would you like to speak/ do a reading:
Special readings for the service (from the bible, verse, books):
Music preferences for the service:
Hymn or song choices for the service:
Who would you like to be pallbearers (optional):
Any special instructions:
List names & phone numbers of next of kin to be informed:
List names, addresses & phone numbers of friends, relatives, clubs, organisations etc you would like contacted:
Your preferred location*
Where your form will be sent & held.

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