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Recording Your Choices

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The following includes the information required by the Registrar – General of Births, Deaths & Marriages.

Please complete fully to ensure your personal details are accurately recorded and your wishes followed.

Download Our Recording your Choices PDF

Recording Your Choices Online Form

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:*
First
Address:
Phone:
Mobile:
First
Address
Phone
Mobile
Name of Employer
Name of Doctor
Name of Funeral Director
Simplicity Plan
- Basic Plan
- Value Plan
- Complete Plan
- Premium Plan
- Custom
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:

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NELSON Ph (03) 539 0066
69 Haven Rd, Nelson, 7010
PO Box 7103, Nelson 7040

RICHMOND Ph (03) 929 5145
276b Queen St, Richmond, 7020
PO Box 7103, Nelson 7040

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