Person in charge of Cremation Arrangements (Executor or Next of Kin)Name* First Middle Last Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email Main Phone*Alternative PhoneRelationship to Deceased* Deceased Person InformationName* First Middle Last Gender*MaleFemaleDate of Death* DD slash MM slash YYYY Date of Birth* DD slash MM slash YYYY Birthplace: City, Province, Country* Deceased's Usual Residence* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Current legal addressSocial Insurance Number The SIN is required to complete the arrangements. If you don't feel comfortable entering the information here, we will call you by telephone to retrieve the SIN.Marital Status*MarriedNever MarriedWidowedDivorcedName of Spouse (maiden name, if wife) Usual Occupation* Occupation prior to retirement or illnessType of Business/Industry* ParentsLegal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.Father's Name* First Middle Last Place of Birth* Mother's Name* First Middle Last Maiden Place of Birth* Did the deceased have or been exposed to COVID 19? Yes No Did the deceased have a Last Will appointing an Executor or Estate Trustee?* Yes No Are you (the person in charge as stated above) the executor?* Yes No Please forward a copy of the first and last page of the WillAccepted file types: pdf, jpg, Max. file size: 300 MB.If not available now, please forward it to us to finalize the arrangements. Are you the nearest surviving relative of the deceased?* Yes No What is the reason the application is by you and not the executor?*Have the near relatives and the Executor, if any, of the Deceased been informed of the proposed cremation?* Yes No Has the Executor, any near relative, or any other person expressed any objection to the proposed cremation?* Yes No Did the Deceased have any of the following: Nitroglycerin patch, Pacemaker or Defibrillator? Yes No Please indicate any implants, patches and/or devices* Nitroglycerin patch Pacemaker Defibrillator Did the Deceased have any infectious or contagious diseases? Yes No Did the Deceased receive implanted microscopic radioactive Brachytherapy treatment, such as TheraSeed? Yes No What was the date of the implant? MM slash DD slash YYYY If you do not know the exact date, please skip this question and let us know as you have the actual date. What is the approximate height of Deceased? What is the approximate weight of Deceased?*0-50lbs50-100lbs100-150lbs150-200 lbs200+ lbsIs the deceased eligible or in receipt of ODSP or Social Service Assistance? Yes No Please provide reference file/case number and contact namesPhoneThis field is for validation purposes and should be left unchanged. Δ
