# Record your Choices

> Record your funeral choices Recording your funeral wishes ensures your ceremony feels right for you. It can also spare your family worry about arrangements. About this form Record your choices online using this form or call us on 07 578…
> URL: https://elliottsfunerals.co.nz/record-your-choices/
> Last modified: 2021-09-17T02:41:40+00:00

# 
		Record your funeral choices
	

	Recording your funeral wishes ensures your ceremony feels right for you. It can also spare your family worry about arrangements.

				
				

## 
		About this form
	

	Record your choices online using this form or call us on **07 578 3338** if you have any questions, or to make an appointment to complete this form together.

	This form has 4 sections:

**1. My personal details

****2. My marriage / civil union

****3. My Family

**These sections of the form record personal information required by the Registrar-General of Births, Death and Marriages.
**4. My funeral details.**

This part of this form is for you to record your wishes for your funeral arrangements.

### 
		Download form
	

	If you prefer to complete forms by hand you can download a copy and print it.

Make sure you send us a copy.
			[Record your choices](https://elliottsfunerals.co.nz/wp-content/uploads/Elliotts-Recording-Your-Choices-WEB.pdf.pdf)

## 
		When you’ve completed the form
	

	You can print a copy for your files. It’s a good idea to let your family know you’ve planned your funeral and keep a copy of your plan with your will.

If you complete the form by hand, forward a copy to us and we’ll keep your plan safe on file.

If you complete the form, we’ll keep your plan safe on file. You can make changes any time, so if you’d like to update it, please get in touch. If you have any questions, or you’d like to arrange prepayment, call us on **07 578 3338**.

## 
		Record your choices
	

                1My Personal Details:2My  Marriage/ Civil Union Details: 3My Family Details:4My Funeral Details:
                                    
- 
## MY PERSONAL DETAILS:

- Choose One:

			
				
				Mr
			

			- 
				
				Mrs
			

			- 
				
				Ms
			

			- 
				
				Miss
			

			- 
				
				Dr
			

- Surname:* 
- First Names:* 
- Name at birth: 
- Address:*
- Email:*
                            
                        
- Phone:*
- Mobile:
- Date of birth:*
                            
                            DD slash MM slash YYYY
                        
- Place of birth:* 
- Are you descended from NZ Maori?:*

			
				
				Yes
			

			- 
				
				No
			

			- 
				
				Don’t Know
			

- Ethnicity: 
- If not born in NZ, what was your date of arrival in NZ: 
- Profession/ Occupation: 
- Full name of father: 
- Occupation of father: 
- Full maiden name of mother: 
- Occupation of mother 
- Do you hold an award/ honours (not military):*

			
				
				Yes
			

			- 
				
				No
			

- Title: 

                          
                        
- 
## MY MARRIAGE/ CIVIL UNION DETAILS:

- Your situation:*

			
				
				Married
			

			- 
				
				Civil union
			

			- 
				
				Divorced
			

			- 
				
				De Facto
			

			- 
				
				Widowed
			

			- 
				
				Separated
			

			- 
				
				Never married
			

- Most current marriage/ union details: 
- Your age at the time: 
- Full name of spouse/ partner at birth: 
- Place of marriage/ union: 
- Spouse/ partner's birth date: 
- 

- Previous relationship details: 
- Your age at the time: 
- Full name of spouse/ partner at birth: 
- Place of marriage/ union: 
- If living, spouse/ partner's birth date: 

                          
                        
- 
## MY FAMILY DETAILS:

- If living, son/s birth date/s: 
- If living, daughter/s birth date/s: 
- Are you a Justice of the Peace:*

			
				
				Yes
			

			- 
				
				No
			

- Are you a Marriage Celebrant:*

			
				
				Yes
			

			- 
				
				No
			

- 
## MY SERVICE RECORD:

- Service number: 
- Overseas/ New Zealand service details: 
- Which war: 
- Rank: 
- Unit/ Regiment: 

                          
                        
- 
## MY FUNERAL SERVICE:

- Name of kin/  executor making the arrangements:*
                                    
                                
- Address:
- Phone:
- Mobile: 
- Name of Solicitor/ person holding will:
                                    
                                
- Address:
- Phone:
- Mobile: 
- Name of Employer: 
- Name of Doctor: 
- Name of Funeral Director: 
- Is the funeral pre-arranged:*

			
				
				Yes
			

			- 
				
				No
			

- Pre-paid:*

			
				
				Yes
			

			- 
				
				No
			

- Preferred Priest/ Clergy/ Celebrant: 
- Venue of service: 
- Casket choice (if known): 
- Choose One:*

			
				
				Burial
			

			- 
				
				Cremation
			

- Plot:

			
				
				None
			

			- 
				
				New
			

			- 
				
				Single
			

			- 
				
				Double
			

			- 
				
				Re-open
			

- Ashes Placement:

			
				
				Scatter
			

			- 
				
				Interment
			

- Cemetery/ Crematorium: 
- Flowers preferred: 
- In lieu of flowers, donations to: 
- Who would you like to speak/ do a reading: 
- Special readings for the service (from the bible, verse, books):
- Music preferences for the service:
- Hymn or song choices for the service:
- Who would you like to be pallbearers (optional):
- Any special instructions:
- List names & phone numbers of next of kin to be informed:
- List names, addresses & phone numbers of friends, relatives, clubs, organisations etc you would like contacted:

          
            
            
            
            
            
            
            
                        
                

### 
		Contact us anytime
	

	Bereavement can be hard. We’re here to talk any time of the day or night.

			[Contact us](https://elliottsfunerals.co.nz/contact/)