This information is for guidance at such time of my death. Preferences on certain subjects have been expressed, and unless changed by unforeseen circumstances, are desired.

WHEN THE NEED ARISES, I DESIRE

that BELL, LAMB AND TROTTER FUNERAL DIRECTORS LIMITED
be contacted to conduct all necessary arrangements for my funeral. A copy of my own personal wishes expressed below is held at their office:

Funeral Service to be held at:

If Other, please specify:

Cremation at:

If Other, please specify:

Burial at:

If Other, please specify:

Burial Plot No. / Ashes to be interred at:

Notices in Newspapers:

If Other, please specify:

Before/After Service:

Age in Newspaper:

Mention of flowers:

Donations to:

Choice of Casket:

Preference of Casket Flowers:

If Other, please specify:

Type/colour:

RSA/Lodge/Clubs/Other Affiliations:

Service Preferences

Catering:

If Other, please specify:

Clothing:

Jewellery to remain:

Jewellery to return:

Amount:

Date:

Further details I would like observed:

DETAILS FOR THE REGISTRAR OF BIRTHS, DEATHS & MARRIAGES

PERSONAL:

Profession/Occupation:

Date and place of birth:

If born overseas: I have resided in New Zealand since

Service Record: Service No:

Rank:

Regiment:

Wartime Service:

I am a Justice of the Peace, Registered Nurse or Title holder of:

NEXT OF KIN:

Name:

Address:

TRUSTEE/EXECUTOR:

Name:

Address:

PARENTS:

Father's Full Name:

Father's Occupation:

Mother's Full Maiden Name:

Mother's Occupation:

Mother's Marital Status:

MARRIAGE:

Spouse's Full Name (Maiden):

Spouse's Date of Birth:

Date and Place of Marriage:

Previous Marriage Details:

Spouse's Full Name (Maiden):

Spouse's Date of Birth:

Date and Place of Marriage:

CHILDREN:

First Name and Date of Birth of Living Children:

OTHER PERSONAL DETAILS:

My Will is held by:

Solicitor:

Society/Club Memberships: