This form helps you to think about all the information that we will ask you when we will talk about your funeral. We suggest you print a copy of it first or, if a printer is not available, we will return a copy to you (in duplicate) for your records.

We also suggest you give a copy to your next-of-kin so that they may acquaint themselves with the details recorded.

If you would like a funeral director to contact you regarding your pre-arrangement, please indicate this on the form. We respect your privacy, therefore no personal contact from Golden Bay Motueka Funeral Services will be made unless requested.

Any field that features a red asterisk (*) next to it’s title is a required field. If you do not know the answer to any required item, please enter the words “not known” so that the form may be properly submitted.

If you need help understanding any areas of the form, please feel free to contact us.

Fields marked with an * are required

 Living Children

Parents

Relationship Status

If in a relationship, please fill in fields below:

If previously in a relationship, please fill in fields below:

Funeral preferences

Next of Kin / Executor

Pre-Paid Funerals

Further comments

Contact information

If you would like Golden Bay Motueka Funeral Services to contact you regarding your pre-arrangement, please fill out your daytime contact details below. No personal contact from Golden Bay Motueka Funeral Services will be made unless the contact information below is complete; therefore, if you do not desire to speak with a Funeral Director, leave these fields blank.

Submit or print the form

Once you have completed all relevant fields, you can either print this form (choose 'Print' from the 'File' menu) or press the 'send' button below to send the form to us. Golden Bay Motueka Funeral Services respects your privacy; your information is confidential and will not be shared with third parties.