C LITTLE & Sons LTDPre-Planning - C LITTLE & Sons LTD

Pre-Planning

There are three ways you can give Notification of Death for Registration (Form - BDM28) with C. Little & Sons website. You can fill the form confidentially below and submit to us for record. If you prefer, we have scanned a copy of the form for you to download Click Here. Or, please contact The Department of Internal Affairs / Birth, Death & Marriage section Click Here to have the form (Form - BDM28) sent directly to you.
Pre-arrangement details:
Personal Information
This information is required to obtain a death certificate
Name of deceased:
1. Name of deceased*
First or given name(s) Surname or family name
2. Name at birth (if different from above)*
First or given name(s) Surname or family name
3. Date of death:*

day
month
year
4. Place of death in full*
8. Sex of deceased:*
- Male
- Female
9. Date of birth:*

day
month
year
Age:*
Enter complete years (e.g. 78). If less than 1 year old use complete months (M), weeks (W), days (D), hours (H), minutes (N) (e.g. 6M)
10. Place of birth*
Town or city Country (if not New Zealand)
11. If not born in New Zealand, number of years lived here
12. Usual home address:*
Flat number (if applicable) / Street number and name Suburb or rural locality City, town or district Country (if not NZ)
13. Usual occupation, profession or job
14. Was the deceased descended from a New Zealand Maori?*
- Yes
- No
- Don't know
15. Which ethnic group(s) did the diseased belong to? Tick the box(es) that apply
- NZ European
- Samoan
- Cook Island Maori
- Chinese
- Maori
- Tongan
- Niuean
- INdian
Other such as Dutch, Japanese, Tokelouan
16. Date of burial, cremation or other disposal of body*

day
month
year
17. Place of burial, cremation or other disposal of body in New Zealand (or place outside of New Zealand to which body proposed to be removed)*
Living Children of Deceased
18. Age of each daughter
19. Age of each son
Parents
20. Parent 1 of Deceased*
- Mother
- Father
21. Parent 1's full name*
First or given name(s) Surname or family name
22. Parent 1's full name at birth (if different from above)
First or given name(s) Surname or family name
23. Parent 1's occupation, profession or job
24. Parent 2 of Deceased*
- Mother
- Father
- **Other parent
**25. Parent 2's full name*
First or given name(s) Surname or family name
**26. Parent 2's full name at birth (if different from above)
First or given name(s) Surname or family name
**27. Parent 2's occupation, profession or job
** Or Other Parent's details
Where the deceased was born as a result of an assisted human reproduction procedure (such as artificial insemination), the details in questions 24 to 27 should be completed as follows:

(1) If the deceased's mother was married to, in on a civil union or de facto relationship with, a man who consented to the mother undergoing the procedure, that man's details should be entered in questions 24 to 27. Do not click the box below.

(2) If the deceased's mother was married to or living in a civil union or de facto relationship with a woman who consented to the mother undergoing an assisted human reproduction procedure (such as artificial insemination) then tick the following box and complete the persons details in questions 24 to 27.
Tick this box if situation (2) applies
Relationship Details of Deceased
28. Relationship status at time of death*
- Married
- In a Civil Union
- Marriage/Civil Union Dissolved
- In a de facto relationship
- Spouse/partner deceased
- Separated from de facto partner
- Permanently separated (from a marriage or civil union)
- Never in a legal relationship
29. Details of most recent relationship (if any)
.
- Marriage
- Civil Union
- De facto relationship
Place of marriage or civil union
Spouse/Partner: full name (when relationship formalised)
Age of deceased at time of marriage/civil union
Sex of spouse/partner:
- Male
- Female
Age, if living
30. If previously in a relationship - list details of second most recent relationship
..
- Marriage
- Civil Union
- De facto relationship
Place of marriage or civil union(1)
Spouse/Partner: full name (when relationship formalised)(1)
Age of deceased at time of marriage/civil union(1)
Sex of spouse/partner:(1)
- Male
- Female
Age of deceased at time of marriage/civil union(2)
Age, if living(1)
31. If previously in a relationship - list details of third most recent relationship
...
- Marriage
- Civil Union
- De facto relationship
Place of marriage or civil union(2)
Spouse/Partner: full name (when relationship formalised)(2)
Sex of spouse/partner:(2)
- Male
- Female
Age, if living(2)
32. If previously in a relationship - list details of fourth most recent relationship
....
- Marriage
- Civil Union
- De facto relationship
Place of marriage or civil union(3)
Spouse/Partner: full name (when relationship formalised)(3)
Sex of spouse/partner:(3)
- Male
- Female
Age, if living(3)
Person Notifying Death
33. Profession or occupation*
34. Name*
35. Contact telephone number*
36. Business or residential address
37. Was the deceased a Marriage Celebrant or Civil Union Celebrant?*
- Yes
- No
38. Was the deceased a Justice of the Peace?*
- Yes
- No
39. Did the deceased hold an honour award? (do not include military decorations)*
- Yes
- No
Funeral Preferences
Name and contact details of my next of kin:
Name and contact details of solicitor who holds my will:
-
- I wish to be buried
- I wish to be cremated
Ashes instructions:
Plot owned
- Yes
- No
If yes. Please enter the cemetery and plot ref:
Place of service:
- C. Little and Sons Ltd
- Other
If Other please specify:
Religion:
Clergy/Celebrant:
Casket:
Hymns:
Readings:
Music:
Flowers:
Donations:
Additional relevant information:
Newspaper notices:
Privacy
C. Little and Sons Ltd. respect your privacy; your information is confidential and will not be shared with third parties.
Email Address:*

If you have any questions regarding funeral pre-planning, or any part of the funeral process, please give C. Little and Sons Ltd a call.

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CALL US ON +64 9 638 9125

Pre-Planning

Pre-arrangement details:

Name of deceased:

Living Children of Deceased

Parents

** Or Other Parent's details

Relationship Details of Deceased

29. Details of most recent relationship (if any)

30. If previously in a relationship - list details of second most recent relationship

31. If previously in a relationship - list details of third most recent relationship

32. If previously in a relationship - list details of fourth most recent relationship

Person Notifying Death

Funeral Preferences

Privacy