Purely Cremation and Burial – Pre Need Biographical Information

Biographical Information

For government documentation purposes,

please provide accurate and complete information

Arrangements for:

Legal First Name:

Middle Name(s):

Any other names used:

Last Name:

Maiden Name (if applicable):

Sex:

Date of Birth (MM/DD/YYYY)

City & Province where born (if outside Canada, state the country)

Social Insurance Number

Type of work done most of their working life

Type of business or industry they worked in

Usual Residence

Unit/Suite #

City, Province

Postal Code

Father's Name (Last Name, First Name & Middle Name)

City and Province of Birth

Mother's Name (Maiden Name, First Name & Middle Name)

City and Province where born

Marital or relationship status (check one)

Last Name of Spouse/Partner

Last name of spouse/partner before this relationship

First and Middle Names

Your Name (if different)

Your Relationship (if not Self)

Your Address

Your Email

Your Phone Number

How did you hear about us?

Next Steps

Biographical Information

For government documentation purposes,

please provide accurate and complete information

Arrangements for:

Immediate Need

Obituaries

Planning Ahead

Send Flowers

Biographical Information

For government documentation purposes,

﻿please provide accurate and complete information

Arrangements for:

Immediate Need

Obituaries

Planning Ahead

Send Flowers

please provide accurate and complete information