Arrangement Form

The form below outlines the information the funeral home will need to collect for Vital Statistics.

It can be completed in advance, as part of pre-arrangements, or at the time of need.

To learn more about at-need arrangements , click here .
To learn more about pre-arrangements , click here .

If a death has occurred, please call us at 604-936-9987, as well as completing the form below.

Vital Statistics Information:

Free Text

Please note the required Personal Health Number and Social Insurance Number can be provided over the phone, if preferred.

Full Name:

Full Address:

Phone Number:

Email Address:

Date of Birth:

Place of Birth:

Date of Death (if applicable):

Place / Facility of Death (if applicable)

Personal Health Number (PHN):

Social Insurance Number (SIN):

Aboriginal Status:

Upload Identification: (Drivers license, Care Card, Passport, Birth Certificate, BC Services Card, Citizenship Card)

Upload File

Occupation (prior to retirement):

Business Type:

Number of Years Worked:

Father's Full Name:

Father's Place of Birth:

Mother's Full Name (Maiden):

Mother's Place of Birth:

Martial Status:

Spouse's Full Name:

Disposition:

Type of Service:

Viewing:

Jewelry:

Pacemaker

Nuclear Therapy Recipient:

Urn Selection:

Casket Preference:

Number of Death Certificates*($27):

'Book of Memories' Complimentary Online Tribute Page:

'Eternity's Touch' Digital Fingerprint

Next of Kin Full Name:

Is this Person the Executor?:

Next of Kin Full Address:

Next of Kin Phone Number:

Next of Kin Email Address:

Miscellaneous Notes and Instructions:

Please select one of the options below:

Please place my information on file

Please contact me to schedule an appointment

Please send me information about pre-arrangements

Please send me information about at-need arrangements

The Book of Memories

Click here to learn more about the complimentary Book of Memories online tribute page.

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Eternity's Touch Fingerprints

Click here to learn more about Eternity's Touch unique fingerprint mementos and keepsakes.

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Cremation Urns

Click here to learn more about the variety of wood, biodegradable and metal urns we offer for every budget.

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Cremation & Burial Caskets

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

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Arrangement Form

Vital Statistics Information:

The Book of Memories

Eternity's Touch Fingerprints

Cremation Urns

Cremation & Burial Caskets

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