As you prepare to complete this form, please note that you don't need to make all decisions now, so only complete as much as you wish (note too that you can change your decisions at any time simply by contacting us).

Once you have completed the form to your satisfaction, please go to the bottom of this webpage and click on "submit" and we will hold your wishes on record (or you can print the form and send it to us).

If you would prefer to have some help in completing the form, or you need more information, simply complete your Name, Address and Phone Number and then submit the form (or use our Contact Us form on this website). We will contact you on receipt.

Funeral Instructions prepared by...
Name:
Email:
Address:
Phone Number:
This funeral arrangement is for:
Myself
Someone else
If someone else, what is your relationship with this person?
 
These details are required by the registrar in order to provide a death certificate.
Full Name:
Maiden name if applicable:
Gender:
Male
Female
Date of Birth:
Place of Birth:
 
If place of birth is not New Zealand, how long have you lived in New Zealand:
Address:
Usual Occupation (before retirement):
Ethnic Group:
 
Childrens Ages
Birth date of each daughter:
Birth date of each son:
 
Parents Details
Mother's full name:
Mother's maiden name:
Mother's Occupation:
Father's full name:
Father's occupation:
 
Marital Status:
Status:
Married
Never Married
Widowed
Marriage Dissolved
Civil Union
Partnered or De Facto
Permanently Separated
If married, complete the following details
Spouse's full name:
Spouse's maiden name if applicable:
Your age at marriage:
Place of marriage:
 
If previously married, complete the fields below
Spouse's full name:
Spouse's maiden name if applicable:
Your age at marriage:
Place of marriage:
 
Next of kin details/Executor of Estate:
Executor(s)/Next of Kin:
Relationship:
Name of Solicitor:
Address of Solicitor:
Date of Last Will:
Will held by:
 
Thank you for completing the form so far. The information requested from hereon is not required by the registrar, but is useful for those organising your Funeral Service. Please only complete as much as you wish, or alternatively, you may go to the bottom of the form now and click submit.
Funeral type:
Burial
Cremation
If burial, preferred cemetery:
If burial, is there an existing plot:
Yes
No
Plot Number (if known):
If cremation, any instructions for ashes:
Preferred funeral venue (if known):
Tauranga Park
Woodhill
Church, please specify
Other, please specify
Religious denomination (if any):
Celebrant/ Minister/ Priest (if known):
Hymns to be sung at the service:
Yes
No
Favourite Hymns:
Music to be played at the service:
Yes
No
Favourite Music:
Bible Readings, Poems or Literature to be read at the service:
Yes
No
Favourite readings, poems or literature:
Favourite flowers for the casket spray:
Armed Serviceman:
Yes
No
Service Number:
Overseas/New Zealand service:
Which war:
Rank:
Unit or regiment:
The RSA is to participate in the funeral:
Yes
No
In lieu of flowers, I would prefer donations to be made to:
 
Remember only complete as much as you wish, or alternatively, you may go to the bottom of the form now and click submit
Viewing:
Family Only
No Viewing
Open Viewing
Casket Selection:
http://www.westerncaskets.co.nz/
I would prefer a custom painted casket. My favourite colour is:
I would like the funeral/death notice to be in the following papers:
I would like the wording for the notice(s) to read:
The funeral service is to be:
Public
Private
Pall bearers:
Other ideas to make the service personal to me:
Refreshments after the Service:
Yes
No
My Notifications
Who should be notified after my death? Clubs and Associations etc:
Other Important Information
Name of Family Doctor:
Address of Family Doctor:

Thank you for taking the time to record these details.
Tick here if you would like a copy of this form sent to your solicitor (we will use the details as shown in the form above).
 

Postal Address:
PO Box 8139
Tauranga
Telephone: 07 576 7941 (all hours)

Making a Lasting Gift

All profits from Legacy Funerals are distributed by the Legacy Trust to local charities.  To date, the Legacy Trust has gifted over $600,000 to the local community - generosity that is only possible because of the choice that families have made in choosing Legacy Funerals.

Legacy Funerals is a member of the Funeral Directors Association of New Zealand.