Funk's Funeral Home, Rosthern, SK (306-232-5245)

Funk's Funeral Home

Rosthern, SK (306) 232-5245
Prearrangement Form / Information Form
DATE

Month Day Year
Information about person completing the form. I am planning for (Choose One)

Myself Spouse Family Member Friend Other
Full Name
Phone Number
Address

Street Address

Mailing address

City Province or State

Postal / Zip Code Country
Email (optional)
Vital information for whom you are planning for.
First Name
Middle Name or Initial
Last Name
Phone Number
Health Card Number
Social Insurance Number (Only needed if pre-paying)
Gender

Female Male
Marital Status

Never Married Married Widowed Divorced Common Law
Birthdate
Place of Birth
Spouse's full name
Spouse's maiden name
Mother's full name
Mother's maiden name
Mother's birthplace
Father's full name
Father's birthplace
Work History
Occupation held in life
Kind of work / business
Funeral Service information
Place of Service / Address & Phone Number
Place or location for viewing or prayers
Religious preference
Viewing for family

Yes No
Viewing for public

Yes No
I prefer Funeral Service to be:

Public Private Family Only
In lieu of flowers, memorial donations accepted to the following charity in memory of a loved one:
1st choice
2nd choice
Upon completing this form please choose one of the following options

Please keep my information on file Please keep my information on file and I would like to prepay Please contact me to discuss these pre-arrangements
Comments
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