My Personal details

Forenames (required)

Surname (required)

Address (required)

Postcode (required)

Telephone(required)

Email(required)

Date of Birth

Next of kin / Executor details

Forenames (required)

Surname (required)

Address (required)

Postcode (required)

Telephone (required)

Email (required)

relationship to me (required)

Funeral Service details

Your chosen type of funeral
CremationBurial

Would you like a religious or non-religious service?

Where would you like the service to be held?

Do you have a preferred officiant? For example your local church minister

Would you like to record who may carry the coffin? (Four or six bearers is appropriate)

Content of the service

Are there any requested scripture readings?

Are there any other literature readings? For example poetry?

Are there any favourite music tracks? This may be three pieces; Entrance, Reflection and exit. Please provide as much information as possible.

Would you prefer an organist?
YesNo

Flowers and donation details

Would you like flowers or donations to a particular charity?
NoneFamily flowers onlyFlowers welcome

Is there a particular charity?

Preparations

How do you wish to be dressed? Please provide extra details if appropriate.
gownMy own clothes

Design of coffin? Would a cardboard, Wicker, Traditional oak veneer, picture coffin or solid Oak coffin be appropriate? If you feel a description is not sufficient then we can provide a catalogue.

If circumstances allow, are you happy for people to visit at our chapel of rest?

The Funeral

Where will the cortege leave from?

Hearse type (e.g. Traditional / horse drawn)?

Number of Limousines (one seats 7 passengers) or for family to use their own vehicles?

Any preferred funeral route?

Reception Venue

After the funeral

If cremated I would like my ashes to be;
Scattered in the Garden of RemembranceInterred in a grave or cremated remains plot at cemetery or churchyardReturned to family for private arrangementsHeld by the funeral director until further instructedOther

Please note any future instructions which haven't been recorded thus far in the box below.
Further notes (required)

Please note ** a copy of your wishes will automatically be sent to the email address given in personal details in the first section of this form.**