Online Arrangement Step 1 of 21 - 1 4% Do you want to make funeral prearrangements or arrangements following a death?* Funeral Pre-Arrangement Arrangements Following Death Did the deceased person have a will?* Yes No Are you the executor or executrix?* Executor Executrix In the absence of a will, the next of kin has the right to make, change or cancel funeral arrangements. Below is a list, by legal order, of the people who can make arrangements for the funeral. (eg: if there is no surviving spouse, the children are responsible). If you are completing documents on behalf of the next of kin, please provide their contact details in the sections below.** Executor or Executrix Husband or wife Children Grandchildren Great Grandchildren Father or Mother Brothers and Sisters Grand Parents Brother or Sister Other BENEFICIARY INFORMATION<5>BENEFICIARY INFORMATION<5>Information About You:Your First Name(Required) Your Last Name(Required) Beneficiary Information: First Name(Required) Last Name(Required) Address*(Required) City(Required) Province(Required) Postal code(Required) Date of Birth*(Required) MM slash DD slash YYYY Place of birth*(Required) Primary Phone Number*(Required) Email Address*(Required) How much does the person you are doing the arrangements for weight?*(Required)Up to 200lbs200lbs to 300lbs300lbs or more ADDITIONAL SERVICESOptional professional services / documents, available to meet your needs.1. Estate Fraud Protection- The Estate Fraud Protection Program offers you a better, easier way to protect your family against identity theft. Upon the death of a loved one, we will immediately notify all necessary government and credit reporting agencies on your behalf. Reporting procedures differ from agency to agency, so we work directly with each to make sure their policies are followed precisely. You can be confident that the right people have been notified in the right way, and that your loved one’s identity and their estate is well protected against fraud.Would you like the Estate Fraud Protection Service for a cost of $135.00?*(Required) Estate Fraud Protection Estate Fraud Protection Service Declined 2. Family Estate Manager - Family Estate Manager is a comprehensive, step-by-step tool that simplifies the decisions you’ll make as you settle your loved one’s estate. This tool provides immediate access to legal professionals that will save you time, notify interested parties, and maximize the value of your estate.Would you like a Family Estate Manager at an additional cost of $295.00?*(Required) Family Estate Manager Family Estate Manager Declined 3. Legal Service Plan -  To help in the process of settling someone’s estate, we offer unlimited 24/7 telephone consultations with our team of experienced estate lawyers. Benefits include a 12-month membership following the death, as well as legal support for other areas of practice including family, employment and residential real estate.Would you like a Legal Service Plan at an additional cost of $295.00?*(Required) Legal service plan Legal Service Plan Declined 4. Digital scan of fingerprint for future purchase of commemorative products - Digital scan of one or more fingerprints, handprints and/or footprints from the Decedent prior to final disposition and are to be used exclusively for purposes of a commemorative keepsake(s) and for no other purpose. For example: Cherish memories with a sterling silver, round, rimmed pendant featuring your loved one's thumbprint or an 18' sterling silver curb style chain.Would you like us to scan a fingerprint sample at no additional cost for future purchase of commemorative products ?*(Required) Please scan a fingerprint sample for future purchase of commemorative products Fingerprint Sample Declined CHOOSE A CREMATION CONTAINER Millsleep Oxford (Wooden base with compressed cardboard top. No Interior.) Price :Included with no-option service package Presswood Container (Basic Presswood Container with no interior) MDF Pine Cremation Container, Batesville (Cremation container with a light pine finish exterior), cloth interior with lining Price CHOICE OF URNSCremated remains will be returned in a temporary urn at no additional cost. Cremation urns contain approximately 200 to 220 cubic inches of cremated remains. These urns are considered normal size. Available in different shapes, materials and colors, the selection of a crematorium urn is a personal and individual choice.Images NATURAL BOX LEATHER CYLINDER SAND RECTANGLE BOIS SILVER MAPLE MOMENTS AZALEA URN AND FRAME KEEPSAKE CHERRY CHEST MOONLIGHT BLUE VASE DOVE VASE MOTHER OF PEARL ELITE SERENITY TREE SERENITY PLAIN LAUREL MIDNIGHT LAUREL WHITE PEARL LIVING URN OMEGA VASE CHOICE OF REMEMBRANCEWe also offer a selection of other urns and souvenirs. Keepsake urns are designed to hold a small portion of the cremated remains. In some cases, you may want to purchase multiple keepsake urns for family members who want to keep some of the total cremated remains while scattering or discontinuing the balance.MOONLIGHT HEART KEEPSAKE MOONLIGHT HEART KEEPSAKE Would you like additional memories for Moonlight Hearth Keepsake?NoYesHow many would you like?Additional memories in the moonlight Additional memories in the moonlight Would you like additional memories for Dove Mini Keepsake?NoYesHow many would you like?LAUREL WHITE PEARL KEEPSAKE LAUREL WHITE PEARL KEEPSAKE Would you like additional memories for Laurel White Pearl Keepsake?NoYesHow many would you like?STAR BRIGHT MINI KEEPSAKE STAR BRIGHT MINI KEEPSAKE Would you like additional memories for Star Bright Mini Keepsake?NoYesHow many would you like?MIDNIGHT PEWTER HEART MIDNIGHT PEWTER HEART Would you like additional memories for Midnight Pewter Heart?NoYesHow many would you like?NIRVANA ADIEU KEEPSAKE NIRVANA ADIEU KEEPSAKE Would you like additional memories for Nirvana Adieu Keepsake?NoYesHow many would you like? NO OPTION SERVICE Included in our No Service Option price of $1845.00 are the following services: Coordinating activities, rites, ceremonies $480.00 Online Professional consultation including, but not limited to, expert advice on options to meet your needs. Our services also includes an online obituary on our website at no additional cost. Registration and Documentation $90.00 Completion and filling of all documents necessary to carry out the services and supplies requested, including, but not limited to, death registration, burial permit, coroner's certificate for cremation & provision of Proof of Death Certificates.Millsleep Oxford cremation container $100.00 Sheltering of remains $190.00 Crematorium fee $795.00 Transportation $190.00Local transfer from place of death*, transfer to GRCS-affiliated crematorium, pick up from GRCS-affiliated crematorium *Addititional distance (beyond 50 km) will be charged at $2.00 per kilometre. Please take a moment to review your arrangements.This total does not include HST and will be applied to the total of services and goods. A copy of your invoice will be sent to you by e-mail, with the total balance due, before accepting the payment.Total Final price does not include taxes or cash disbursements INFORMATION ABOUT YOU As the person authorized to carry out these arrangements, please complete the following forms. Guidance will be provided along the way to explain certain terms, should you require individual assistance at anytime please call us at XXX-xxx-xxxINFORMATION ABOUT YOUYour First Name(Required) Your Last Name(Required) Address*(Required) City State / Province / Region CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsZIP / Postal Code Phone Number*(Required) Confirm Email*(Required) Enter Email*(Required) DEATH REGISTRATION FORM FOR THE CIVIL STATUS OFFICEThe information requested below helps us register the death with the Vital Statistics Agency. This form asks you to provide information on the parents of the deceased, their names at birth and place of birth, as well as information on the deceased (profession, residence, etc.).First Name *(Required) Last Name Home Address*(Required) Apartment City*(Required) Postal code*(Required) What is the gender of the deceased?*(Required) Male Female Health Card Number Place of Birth Date of Birth*(Required) MM slash DD slash YYYY Date of Death*(Required) MM slash DD slash YYYY Type of work done most of working life*(Required) Type of business or industry that the deceased worked in most of working life*(Required) Civil status of the deceased*(Required)SingleMarriedWidowDivorcedCommon-law PartnerFormer Common-law PartnerName of the Father of the Deceased City & Province where Father was born Name of the Mother of the Deceased City & Province where Mother was born Did the death occur in Québec* Yes No Spouse's First Name Spouse's Maiden Name How much does the person you are doing the arrangements for weight?*(Required)Up to 200lbs200lbs to 300lbs300lbs or morePlace of Death*(Required)HospitalRetirement HomeHomeOtherThe online arrangement section of our website is not monitored 24 hours a day. If the death occurred at a residence or nursing home, please call us immediately at 1-888-966-4727. (If selected Retirement Home, Home, Other)Please indicate the name of the establishment or the address*(Required) Is your loved one still at the above place of death?* Yes No MEDICAL TREATMENT AND HISTORY OF THE DISEASE Does the person that you are doing the arrangements for have a pacemaker and/or other implanted medical devices?(Required) Yes No Please list the implant here. CONFIRMATION OF ITS IDENTITYConfirmation of non-visual identity. Grand River Cremation Services will ensure confirmation of your loved one’s identity is completed using a recent photo, or, if needed, an alternative means of confirmation. Please upload a photo here: Drop files here or Select files Max. file size: 2 MB. Describe the alternative methods used to confirm identification (Recent photos, scars, tattoos). Optional professional services / documents, available to meet your needs. ADDITIONAL SERVICES 1. Estate Fraud Protection- The Estate Fraud Protection Program offers you a better, easier way to protect your family against identity theft. Upon the death of a loved one, we will immediately notify all necessary government and credit reporting agencies on your behalf. Reporting procedures differ from agency to agency, so we work directly with each to make sure their policies are followed precisely. You can be confident that the right people have been notified in the right way, and that your loved one’s identity and their estate is well protected against fraud.Would you like the Estate Fraud Protection Service for a cost of $135.00?* Estate Fraud Protection Estate Fraud Protection Service Declined 2. Family Estate Manager -   Family Estate Manager is a comprehensive, step-by-step tool that simplifies the decisions you’ll make as you settle your loved one’s estate. This tool provides immediate access to legal professionals that will save you time, notify interested parties, and maximize the value of your estate.Would you like a Family Estate Manager at an additional cost of $295.00?*(Required) Family Estate Manager Family Estate Manager Declined 3. Legal Service Plan -   To help in the process of settling someone’s estate, we offer unlimited 24/7 telephone consultations with our team of experienced estate lawyers. Benefits include a 12-month membership following the death, as well as legal support for other areas of practice including family, employment and residential real estate.Would you like a Legal Service Plan at an additional cost of $295.00?*(Required) Legal service plan Legal Service Plan Declined 4. Digital scan of fingerprint for future purchase of commemorative products -   Digital scan of one or more fingerprints, handprints and/or footprints from the Decedent prior to final disposition and are to be used exclusively for purposes of a commemorative keepsake(s) and for no other purpose. For example: Cherish memories with a sterling silver, round, rimmed pendant featuring your loved one's thumbprint or an 18' sterling silver curb style chain.Would you like us to scan a fingerprint sample at no additional cost for future purchase of commemorative products ?*(Required) Please scan a fingerprint sample for future purchase of commemorative products Fingerprint Sample Declined CHOOSE A CREMATION CONTAINER Millsleep Oxford (Wooden base with compressed cardboard top. No Interior.) Price :Included with no-option service package Presswood Container (Basic Presswood Container with no interior) MDF Pine Cremation Container, Batesville (Cremation container with a light pine finish exterior), cloth interior with lining Price CHOICE OF URNSCremated remains will be returned in a temporary urn at no additional cost. Cremation urns contain approximately 200 to 220 cubic inches of cremated remains. These urns are considered normal size. Available in different shapes, materials and colors, the selection of a crematorium urn is a personal and individual choice.Images NATURAL BOX LEATHER CYLINDER SAND RECTANGLE BOIS SILVER MAPLE MOMENTS AZALEA URN AND FRAME KEEPSAKE CHERRY CHEST MOONLIGHT BLUE VASE DOVE VASE MOTHER OF PEARL ELITE SERENITY TREE SERENITY PLAIN LAUREL MIDNIGHT LAUREL WHITE PEARL LIVING URN OMEGA VASE CHOICE OF REMEMBRANCEWe also offer a selection of other urns and souvenirs. Keepsake urns are designed to hold a small portion of the cremated remains. In some cases, you may want to purchase multiple keepsake urns for family members who want to keep some of the total cremated remains while scattering or discontinuing the balance.MOONLIGHT HEART KEEPSAKE MOONLIGHT HEART KEEPSAKE Would you like additional memories for Moonlight Hearth Keepsake?NoYesHow many would you like?DOVE MINI KEEPSAKE DOVE MINI KEEPSAKE Would you like additional memories for Dove Mini Keepsake?NoYesHow many would you like?LAUREL WHITE PEARL KEEPSAKE LAUREL WHITE PEARL KEEPSAKE Would you like additional memories for Laurel White Pearl Keepsake?NoYesHow many would you like?STAR BRIGHT MINI KEEPSAKE STAR BRIGHT MINI KEEPSAKE Would you like additional memories for Star Bright Mini Keepsake?NoYesHow many would you like?MIDNIGHT PEWTER HEART MIDNIGHT PEWTER HEART Would you like additional memories for Midnight Pewter Heart?NoYesHow many would you like?NIRVANA ADIEU KEEPSAKE NIRVANA ADIEU KEEPSAKE Would you like additional memories for Nirvana Adieu Keepsake?NoYesHow many would you like? After cremation Once the cremation is complete, you have the option of having the cremated remains, death certificates and other necessary documents returned to you by mail, home delivery or collection at our office.How would you like the cremated remains returned? Collect cremated remains at the funeral home Returned via Registered Mail ($100) NO OPTION SERVICEIncluded in our No Service Option price of $1845.00 are the following services: Coordinating activities, rites, ceremonies $480.00 Online Professional consultation including, but not limited to, expert advice on options to meet your needs. Our services also includes an online obituary on our website at no additional cost.Completion and filling of all documents necessary to carry out the services and supplies requested, including, but not limited to, death registration, burial permit, coroner's certificate for cremation & provision of Proof of Death Certificates.Registration and Documentation $90.00 Millsleep Oxford cremation container $100.00 Sheltering of remains $190.00 Crematorium fee $795.00 Transportation $190.00Local transfer from place of death*, transfer to GRCS-affiliated crematorium, pick up from GRCS-affiliated crematorium *Addititional distance (beyond 50 km) will be charged at $2.00 per kilometre. Please take a moment to review your arrangements.This total does not include HST and will be applied to the total of services and goods. A copy of your invoice will be sent to you by e-mail, with the total balance due, before accepting the payment.Total Final price does not include taxes or cash disbursements
