Immediate Funeral Plan

First Name

Last Name

Phone/Mobile

Address Line 1

Address Line 2

City

State

Zip Code

Country

Financial arrangements (Select all that apply and give details)

How will the funeral be paid for?

Who’s in charge?

I am an executor/administrator of the estate/ relative with responsibility for arranging the funeral. I understand that I shall be responsible for paying my chosen funeral director’s bill plus all third-party fees.

I am the parent/guardian of the person who has died and and I understand that I shall be responsible for paying my chosen funeral director’s bill and all third-party fees.

What is your financial position?

I have access to funds which will enable me to pay the funeral director within thirty days of the funeral

I have limited means and I shall be seeking financial assistance from the social fund

Checkbox Field

Would you like information on probate services to assists in financial matters?

Is the person under 16?

Where is the person?

The home address of the person who has died is:

Address Line 1

Address Line 2

City

State

Zip Code

The person is presently at:

Address Line 1

Address Line 2

City

State

Zip Code

Is cost an important factor for you ?

Must be kept as low as possible

Have no strong feeling about the cost of the funeral

No expense will be spared

Burial or cremation?

Would you like the person to be buried or cremated?

Buried

Cremated

Do you want the person to be at the funeral?

I want to have a funeral at which the person will be present

I want the person to be buried or cremated without ceremony.**

I want the person to be buried

At any convenient location

At the following location

Please specify the location

I want the person to be cremated

At any convenient location

At the location of my choice

Please specify the location

I want my ashes to be

Returned to my next-of-kin

Scattered at the crematorium.

What is the height of the person?

Feet / Inches / Centimeters

What is the weight of the person?

Stone / Pounds / KG

What is the width of the person?

Feet / Inches / Centimeters

If the person weighs more than 20 stone, and the person is to be cremated, please check the following:

I understand that the coffin may be too large for the crematorium of my choice.

Care Of Your Body

Where do you want the person to be before the funeral?

So as long as the person do not die of a notifiable disease I want the body to

Spend all the time before the funeral at the funeral home

Spend all the time before the funeral at the persons (or family) home, cared for with the assistance of a funeral director

Spend all the time between death and the funeral at home where the assistance of a funeral director will not be needed.

To remain in the hospital mortuary, if possible until the day of the funeral.

To spend some days at home and the rest of the time at the funeral home

Enter the number of days

What are your wishes concerning invasive treatments?

I want the person to be embalmed

I agree that the body may be embalmed only if the funeral director deems it absolutely necessary.

I do not want the person to be embalmed

Mouth

I permit the mouth to be closed by means of a suture

I require the mouth to be closed, if possible, by a support

I do not want the mouth to be kept closed by any artificial means

Does the body of the person show the effects of injury?

Please Provide Information

Who will wash and dress the person?

I want the person to be washed and dressed by those who are caring for me at home

With the help of the funeral director at home

By the funeral director at the funeral home

With the help of the funeral director at the funeral home

According to religious ritual

Please describe the religious ritual

Do you want a same-sex funeral director to wash and dress the person?

I want a same-sex funeral director to wash and dress the person

I do not require a same-sex funeral director to wash and dress the person

While the washing and dressing of my body is being carried out

I Don't want music to be played

I would like this music to be played

Please mention the song / music name

What would you like the person to be dressed in?

I wish the person to be dressed in their own clothes / Dressing gown

I would like the person to be dressed in a gown supplied by the funeral director

Funeral Director look

Please take steps to make the person look at their best; i.e. Hair and Make-up?

Do you want anyone to visit the person?

I would like it to be possible to visit the person at the funeral home

It will not be required to visit the person before the funeral

When the person is visited

I want there not to be religious imagery in view

I am indifferent as to whether or not there will be religious imagery in view.

I want there to be religious imagery in view

Please provide the details

Your coffin

The coffin I have selected is

Funeral Ceremony

Would you like the funeral to be:

By invitation only

Open to anyone who wants to attend

Open to anyone who wants to attend except some individuals

List of Individuals

Where would you like the funeral ceremony be held?

I would like my funeral ceremony to be held at a preferred venue, named

The crematorium chapel

I do not mind where the funeral service is held

Venue Name

Where would you like the funeral ceremony be held?

I would like my funeral ceremony to be held at a preferred venue, named

The cemetery chapel

The natural burial ground

I do not mind where the funeral service is held

Venue Name

If your funeral ceremony is to be at the crematorium, how long do you expect it to last?

The ceremony at the crematorium is likely to exceed 20 minutes and I shall probably need a double slot

The ceremony at the crematorium is likely to fall comfortably within 20 minutes and I shall need a single slot

How do you want the person to travel to the funeral?

I want the person to travel to the funeral in the funeral director’s own hearse

I want the funeral director to arrange for a special hearse

Vintage hearse

White hearse

Silver hearse

Rolls Royce hearse

Pink hearse

1974 Cadillac hearse

Bluebell hearse

Hand bier or handcart

Horse-drawn hearse

Motorcycle hearse

vintage lorry hearse

4x4 hearse

VW campervan hearse

estate car or similar

I shall not require the funeral director to provide a vehicle

Other type of hearse not listed here

Other type of hearse

Do you want to reach the venue and be in place before the mourners arrive?

Yes

Would you like there to be a procession?

I do not want there to be any sort of funeral procession

I want the undertaker to walk in front of the hearse according to custom

This is how I would like the funeral procession to be specify

Please Specify

Would you like close friends and family to follow the hearse in limousines?

I do not want anyone to follow my hearse in a limousine

I would like close friends and family to follow the hearse in limousines, please specify how many:

How specify the number

Who will carry your coffin?

I require the funeral director to provide all 4 bearers to carry my coffin.

I prefer that coffin to be carried by the funeral directors trolley

I wish the coffin to be carried by the following people

Please provide the name, phone no and email

Additional Bearer

The funeral director will need to supply some addional bearers

Please specify the number

Who will lead your funeral service?

I want my funeral service to be led by

A faith leader

A humanist celebrant

A civil celebrant

A multifaith minister

Other or the name of a specific person you want to use

Please provide the details of person

If you have chosen to be cremated

No one will wish to witness the coffin going into the cremator

Chosen people will wish to witness my coffin going into the cremator/

Please provide the details of the people

How do you want the funeral director to be dressed?

I want the funeral director to be dressed

In formal attire (top hat, frock coat, etc)

In a business suit

other specified

Please provide the details

What will be the role of the funeral director? choose one or more of the following:

I want the funeral director to

Be master of ceremonies, in charge of the event

Play no part at all beyond driving me to the funeral; those arranging my funeral will be the hosts

Record the names of those who attend

Show mourners to their seats

Your funeral flowers

I do not want to have flowers

The flowers I would like to have are

Name of the flower

Would you like the funeral flowers to travel in the hearse?

Those arranging the funeral will acquire flowers from

My garden

The funeral home’s supplier

My own chosen supplier specify

What music would you like played at your funeral?

I have no strong feelings about what music is played at my funeral

There is a specific music I would like to be played at my funeral

Please mention the music name

Do you have any general thoughts and ideas about how you would like the funeral to be?

I have no strong feelings about how I would like the funeral to be and would like to be advised by the Funeral director

My thoughts about my funeral are that it should be

Please mention your thoughts

Would you like any of these special services at the funeral?

I would like there to be a piper

I would like there to be live musicians/singers.

I would like there to be a multimedia presentation.

I would like there to be doves

I would like there to be balloons

Any other special service

Please mention other special service

Would you like your funeral to be filmed or photographed?

I would not want the funeral to be webcast, filmed or photographed

Yes I would like the funeral filmed, photographed, or webcast.

Please choose the below options

I would like my funeral to be filmed

I would like my funeral to be webcast

I would like my funeral to be photographed

Would you like there to be a reception after the funeral?

I do not want there to be a reception after the funeral

I would like there to be a reception after the funeral,

The food I would like to be served at my funeral is

The drink I would like to be served at my funeral is

These are my feelings about how I would like the reception after my funeral to be, please add any details including venue:

Your Ashes

What would you like to be done with the ashes after the cremation?

I shall require an urn for the ashes.

I would like the ashes to be

Please Specify

The Memorial

Would you like a headstone, or Memorial Stone?

I do not want a headstone

I would like a headstone. Please give details

The inscription I would like on my headstone is

Would you like any other kind of memorial?

Park bench

Newspaper notice

Garden Memorial

Any other type of memorial

What inscription would you like on the bench?

Please detail which newspaper(s) & What would you like the notice to say ?

Please describe what sort of memorial you have in mind?

Please specify other type

Is there anything else you want to say about the funeral?

Financial arrangements (Select all that apply and give details)

Where is the person?

Burial or cremation?

Care Of Your Body

Your coffin

Funeral Ceremony

Who will lead your funeral service?

How do you want the funeral director to be dressed?

What will be the role of the funeral director? choose one or more of the following:

Your Ashes

The Memorial

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