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My Funeral Wishes

Please complete this form to record your funeral wishes. If you have any problems completing the form, please call us. We are a friendly team who are passionate about what we do.



Email Address*

Phone Number*

Date of Birth

Type of Funeral Service

Please tell us your preferences and final place of rest.

In the event of my death, I wish to be:
Please select your preference

 Cremated Buried

If Cremation:
Please tell us how you would like your ashes to be dealt with

 Scattered at the crematorium in the Garden of Remembrance (or at a different crematorium) Collected by the family from the crematorium Interred at a cemetery or churchyard (please specify where) Held by Chelsea Funeral Directors

Other Information for cremation
Please provide other information such as name of preferred cemetery, churchyard or specific grave.

If Burial:
Please select all appropriate options

Other Information for Burial
Please provide any other information, such as grave owner, grave number, name of cemetery/churchyard etc.

My Faith / Belief
Please select your faith or belief

 Church of England Roman Catholic Methodist Baptist Church of Scotland Church of Wales Hindu Judaism Muslim Sikh No Faith Other (Please Specify)

If Other, please specify

Preferred Minister/Officiant (if known)

Before The Funeral

This section advises us of your wishes prior to the day of your funeral.

How would you like to be dressed?

 No thank you My own clothes In a funeral robe

Coffin Type
All our coffins are suitable for cremation or burial.

 Solid Veneer Willow Seagrass Wicker Bamboo Picture Coffin (please advise theme) Cardboard

Do you wish people to see you before the funeral?

 No Yes

Where would you like the coffin to rest prior to the funeral?

 To remain with the funeral director Taken to the place of the service Taken home

The Day of The Funeral - My Last Journey

Let us know how you would wish your last journey to be made

Preferred Transport

 Horsedrawn Hearse Traditional Motor Hearse Motorcycle Hearse Other

If Other, please specify

Funeral to Commence From
This could be Your Home, the Funeral Home or somewhere else that is important to you.

Flowers and Donations

Please advise us on your floral preferences and whether you have preferred charities that you would like to benefit in lieu of flowers.

Floral Tributes

 Family and Friends Family Only None

My preferred charities are
Please specify the name of the charities to whom donations should be sent

Contents of the Service or Ceremony

Please tell us your wishes for your service. You may include as much detail as you wish, or leave this section blank so your family can decide.

Music Choices
Please list all music and hymns that you would like to be played or sung, at the start, during and the end of the service.

Specific Readings/Poems

Individuals for Tributes & Readings
Please advise us of the names of individuals you wish to read at your service.

Any Other Requests
Please advise us of any other wishes you have.

Paying For Your Funeral

You may already have a funeral plan, in which case this can be transferred to us if you wish. If you don't, there are many ways to pay for your funeral. Please select one of the options below

 I would like details of a Golden Charter Funeral Plan My estate My family My funeral plan (Please specify who this is with) My insurance policy

My Next of Kin or Personal Representative

Please include the name and contact details of the person that is most likely to deal with your funeral arrangements. This may be a member of your family, a close friend, your executor or your solicitor.



Email Address
Email Address for Next of Kin or Personal Representative

Phone Number
Phone Number for Next of Kin or Personal Representative

Thank You

Thank you for completing our enquiry form. Please now complete this by clicking on 'Submit' below. One of our team will be in touch with you to follow up on your wishes in the next two days.

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