Pre planning

Your contact details (as next of kin)

*Required

 Name*  
Daytime Phone Number*  
Mobile Phone Number*  
Email Address*  

 

Personal information relating to the deceased

This information is required to obtain a death certificate

*Required

Date of Birth 
Place of Birth*  
Address*  
   
   
   
City*  
Occupation*  
Ethnic Group*  
NZ Maori Descent* Yes No  

Living Children

*Required

Birthdates(s) of Daughter(s)
Birthdates(s) of Sons(s)

Parents

*Required

Mothers Full Name*
Mothers Full Name at Birth*
Mothers Occupation*
Fathers Full Name*
Fathers Occupation*

Relationship Status

*Required

Status at time of death* Married
In a Civil Union
Marriage/Civil Union Dissolved
Marriage/Civil Union Permanently Separated
In a de facto relationship
Separated from de facto partner
Never in a legal relationship

 
Spouse/Partner Full Name*  
Spouse/Partner Maiden Name*  
Your age at Marriage/Union*  
Place of Marriage/Union*  
Spouse's Birthday  
Sex of Spouse/Partner* Male Female  

If in a previous relationship please fill in the details in the fields below
Spouse/Partner Full Name*  
Spouse/Partner Maiden Name*  
Your age at Marriage/Union*  
Place of Marriage/Union*  
Spouse's Birthday  
Sex of Spouse/Partner* Male Female  

If there were earlier Marriages/Unions please note the details below

Funeral Preferences

*Required

Place of Service*
Manning Funerals Chapel, Church,
Crematorium, Other
Religion   
Officiant*
 
Music to be played*  
Music to be sung*  
Is an Organist required* Yes No  
Favourite Bible Readings  
Favourite Literature or Poems  
Favourite Flowers  
Favourite flower colour*  
Final Placement* Cremation Burial  
Preferred Crematorium*  
Placement of Ashes*  
Preferred Cemetary*  
Plot Owned* Yes No  
Plot Cemetary Reference*  

 

Further Comments

If you wish to record other requirements that are not explicitly catered for above, please enter these below

Pre-arrangement follow up

Would you like Mannings Funerals to contact you regarding your pre-arrangement?
 
Follow up this submission? Yes No  

Privacy

 
Manning Funerals respects your privacy; your information is confidential
and will not be shared with third-parties