Arrangement Form

Status

Please select the status of the person the arrangements are being made for:

Informant's Information

Please enter the information of the person filling out this form

Next of Kin's Information

Is there a will?

In order to make final arrangements we will require the executor's participation and permission.

Is the above person the executor of the will?

Is the above person the legal next of kin?
Please enter the information of the executor of the will or legal next of kin below (if different from the above).

Arrangements For

Gendre

Marriage Information

Spouse Information

Spouse's Sex MaleFemale

Safety Information

Is there a pacemaker present?
Was death due to an infectious or contagious disease?

Are there any radioactive implants (e.g. seeds)?
Does the deceased weigh in excess of 225 lbs.?

Government Agencies

Other government agencies to be notified of the death

As far as you know, was the deceased receiving benefits from the Commission administrative des régimes de retraite et d'assurances, or contributing to a pension plan administered by the Commision?

As far as you know, was the deceased under protective supervision?

If Yes, indicate the deceased's situation

As far as you know, was the deceased the legal representative of an incapable person?

If Yes, indicate the deceased's status


As far as you know, had the decased submitted an application for benefits under the Québec Parental Insurance Plan, or was the deceased receiving benefits for an upcoming or recent birth or adoption?

As far as you know, was the deceased a building contractor, a guarantor or an owner-builder holding a licence issued by the Régie du bâtiment du Québec?

If Yes, enter the licence number.

As far as you know, did the deceased have Indian status as recognized by the federal government under the Indian Act?

If Yes, enter the information requested below.



As far as you know, did the deceased have Cree or Naskapi beneficiary status, as recognized by the Québec government under the Act respecting Cree, Inuit and Naskapi Native Persons?

If Yes, enter the information requested below.


As far as you know, did the deceased hold a firearms licence?

If Yes, and you know the firearms licence number, enter the first eight digits below.

As far as you know, did the deceased possess one or more firearms?

As far as you know, did the deceased hold a driver's licence issued by the Société de l'assurance automobile du Québec?

If Yes, enter the driver's licence number below.

As far as you know, was the deceased receiving benefits from the Commission de la santé et de la sécurité du travail (income replacement indemnities, death benefits, the reimbursement of drug costs, the payment of the cost of a hearing aid, personal home assistance allowances, care or treatment, etc.)?

If Yes, and you know the file number, enter it below.