Pre-Arrangement Form

Pre-arrange your funeral

By completing the following form you are well on your way to taking a responsible first step in pre-arranging your funeral. Your form submission is completely confidential. However, we do not consider the completion of this form as solicitation, and we will only contact you at your request. If you wish, we can provide you with a printed copy to keep for your personal records. Please use the following form to assist in pre-arranging your wishes for a meaningful, personally selected funeral.

The items marked with an asterisk are required items for the completion of government legal forms and should be completed in full if possible.

PERSONAL INFORMATION

* First Name

* Middle Names

* Last Name

* Address

* Town/City

* Province

* Postal Code

Telephone Number

Email Address

* Date of Birth

* Place of Birth (Give Land Numbers if Rural)

* Spouses Name (Maiden name and full name of wife or husband’s full name)

* Occupation (for longest period during working life)

Social Insurance Number

* Health Card Number

* Father’s Full Name

* Father’s Place of Birth (Give Land Numbers if Rural)

* Mother’s Maiden Name

* Mother’s Christian Names

* Mother’s Place of Birth (Give Land Numbers if Rural)

PERSON WHO WILL BE IN CHARGE OF MY FUNERAL ARRANGEMENTS

Name

Address

Town/City

Province

Postal Code

Telephone Number

WILL & EXECUTOR

Location of Will:

Name

Address

Town/City

Province

Postal Code

Telephone Number

MILITARY INFORMATION

Veteran's Service Number

Rank

Location of Discharge Papers

NEXT OF KIN

Spouse
(Addresses, and phone numbers)

Daughters
(List their spouses, addresses, and phone numbers)

Sons
(List their spouses, addresses, and phone numbers)

Grandchildren
(List their spouses, addresses, and phone numbers)

Sisters
(List their spouses, addresses, and phone numbers)

Brothers
(List their spouses, addresses, and phone numbers)

Other Relatives
(List their spouses, addresses, and phone numbers)

MY PREFERENCES

Place of Service

Clergy

Please choose a service type:

BURIAL

Preferred Casket

Name of Cemetery

Grave Location

CREMATION

Preferred Cremation Casket

Preferred Urn

Final Urn Placement
(Burial, Home, Scatter, Columbarium - Please Describe)

Monument, Marker, or Memorial
(Type, Material and Preferred Inscription)

Pallbearers or Honorary Pallbearers

Lodge, Society, Fraternal Organization
(List involvement and if you would like an honor guard)

Music Selections

Flowers

Memorial Donations

Funeral Service Card
(Type of design, photo, and verse)

Obituary Information
(List education and place of schooling, wedding date and place, work history and places I lived and worked, Clubs, Lodges, Hobbies, what I liked doing, significant accomplishments, Boards, Committees and community and Church involvement, etc.)

LOCATION OF IMPORTANT PAPERS

We all collect important documents and papers. It is essential that numerous items be taken care of. The following items are not part of making funeral arrangements but the information will be very useful for your survivors. You may wish to complete the following list to provide additional assistance to them. If you do not wish to complete this portion at this time it would be helpful for you to make a list on your own at a later date.

Please complete in full including the location of each item

Birth and Marriage Certificates

Insurance Policies

Bank Accounts and Account Numbers

Stock and Bond Certificates

Automobile Records

Description of property owned
(List locations and mortgage holders)

Retirement Plan and Company Benefits

Safety Deposit Box and location of key

Physicians

Accountant and Attorney
(List address and telephone numbers)

Credit Cards and Numbers

Other Valuables and Benefit entitlements

Any other information or instructions not previously listed

Please check as many of the following as apply:

Please contact me. Please forward me a copy of my information for my records. Please contact me if any of my submitted information needs clarification. File my information for future reference at Binkley’s Funeral Service (Shaunavon) Ltd. but Please do not contact me. I would like to discuss my pre-payment options with no obligation, please contact me.

If you would prefer a printed copy of this form to complete in the privacy of your own home you may print this form by clicking here. Once you have completed the form please forward it to

Binkley’s Funeral Service (Shaunavon) Ltd.
P.O. Box 207
Shaunavon, SK S0N 2M0

or simply provide a copy for your family.

Get in Touch

Binkley's Funeral Service (Shaunavon) LTD

206 Centre Street

Shaunavon, SK S0N 2M0

Phone: (306) 297-2412

Toll Free: 1-877-BINKLEY (246-5539)

Fax: (306) 297-2902