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Lasting wishes

No matter the stage in your life, it is important to prepare your lasting wishes so that your family and loved ones know how you’d like to leave.

Our lasting wishes service is free and is now online. You can fill out our online lasting wishes form (below) or contact one of the team on 01534 737291 or at funerals@maillardsfunerals.co.uk for further information.

Lasting Wishes Form (full)

Please answer all questions to the best of your ability, the more information we receive from you the easier the planning for your funeral will be for your loved ones. This form may take up to 5 minutes to fill out.

Title *

First

Last

Previous names:

Maiden names:

Date of Birth: *

Place of Birth:

(please provide a copy of your birth certificate, if available, if not born in Jersey)

Address: *

Phone number/s: *

Email *

Next of kin/executor: *

Relationship: *

Is your next of kin aware of your wishes? *

Yes
No
Other

Next of kin phone number: *

Next of kin address: *

GP name: *

Surgery: *

Do you have a will? *

Yes
No
Other

If yes, where is it stored?

Do you have an existing funeral plan? *

Yes
No
Other

If yes who with?

Would you like to be buried or cremated *

Buried
Cremated
Other

Where would you like to be buried?

Do you or your family own a grave/plot? *

Yes
No
Other

If yes please leave details of where this is.

Where would you like your funeral service to be held?

Would you like your service to be open or private? *

If cremated, what would you like to do with your ashes?

Would you like your ashes in a scatter tube plain, patterned or wooden?

Plain
Patterned
Wooden
Other

Do you have a religion?

If so what religion?

Would you like a religious or non-religious service? *

Religious
Non-religious
Other

Preference as to who you would like to take the service?

Would you like family cars? *

Yes
No
Unsure

Our Limousines can carry up to 7 passengers.

Family car in procession with the hearse or coffin in place when people arrive? *

Procession
In place
Other

Would you like service sheet?

Yes
No
Other

Would you like attendance cards? *

Yes
No
Other

Would you like hymns?

Yes
No
Other

If yes which hymns?

Names of hymns.

Hymns can be on CD or sung live at the service with an organist - please state your preference

CD
Sung live
Other

Would you like CD/other music-processional, reflection, recessional? If so what are you choices? *

Would you like your service live streamed and/or recorded?

Yes
No
Other

Would you like a notice to go in the JEP? *

Yes
No
Other

usually a death notice followed by a funeral notice

What coffin would you like? *

Windsor
Solid oak
Kindale mahogany
Solid mahogany
Kindale oak
Tulip wood
Pandanus and Rattan
Wicker
Plain Elm
Other

Some coffins can be painted, what colour would you like painting if any?

What colour coffin handles would you like? *

Gold
Silver
Wooden
Other

What would you like to wear in you coffin? *

Own clothes
Silk robe
Other

If you chose silk robe what colour?

Do you object to people coming to view/say goodbye to you in our chapel of rest? *

Yes
No
Other

Would you like flowers? *

Yes
No
Other

If so what kind and preferred colour?

(A coffin spray is normally 3.5 to 4 foot long)

Would you like family flowers only or from others too?

Family flowers only
Flowers from anyone
Other

Would you like donations made in your memory? *

Yes
No
Other

If yes which charity/ies?

Additional information / special instructions:

write as much or as little as you need.

No matter the stage in your life, it is important to prepare your lasting wishes so that your family and loved ones know how you’d like to leave.

Lasting Wishes Form (short)

Nominator Details

First Name

Middle Name

Surname

Maiden Name

Date of Birth

Place of Birth

Address

Phone Number

Email (required for confirmation)

Next of Kin/Executor

Next of Kin/Executor relationship

Is your Next of Kin/Executor aware of your wishes?
YesNoUnsure

Next of Kin/Executor email address/postal address

Next of Kin/Executor Phone number

Please state your GP

Please state your GP Surgery's address

Do you have a will?
YesNo

If answered YES where is your will located?

Do you have an existing funeral plan?
YesNo

If answered YES who is your funeral plan with?

Would you like to be buried or cremated?
BuriedCremated

Where would you like your funeral service to be held?

Place of burial?

Would you like your funeral service to be open or private?
OpenPrivateUndecided

If cremated, what would you like to do with your ashes?

Do you have a religion?

Please choose one option from the list below
I would like a minister to take my serviceI would like a celebrant to take my serviceI don't mind who takes my serviceI am undecided as to who I'd like to take my service

What transport would you like? Be it Hearse, horse-drawn, limousine, motorbike, tractor and family transport please let us know your preference.

Would you like a service sheet?
YesNoUndecided

If you answered YES estimated quantity

Would you like attendance cards?
YesNoUndecided

Would you like music played at the service and if so, what type? Hymns and or CD's
Please include artist or song titles or if you know or a musician if you'd like live music.

Would you like a notice in the Jersey Evening Post and our website?
YesNoUndecided

What is your preferred casket or coffin type?
You can view our range of coffins at Maillards Funerals
WindsorWindsor MahoganySolid Oak 3 Panel SidesSolid MahoganySolid Mahogany 3 Panel SidesKindale OakKindale Oak CasketKindale MahoganyKindale Mahogany LinedKindale Mahogany CasketCardinal Solid Oak Panel Sided CasketCardinal Solid Oak High Lid CasketCardinal Solid Mahogany Panel Sided CasketPandanus and RattanPlain Elm

Please choose preference of clothing?
Own clothesSilk robe

If you chose Silk robe please state preferred colour.

Would you like friends and family to say goodbye to you?
This goodbye takes place at the Maillards Chapel of Rest.
YesNoUndecided

Would you like flowers at your funeral?
YesNoUndecided

If you answered YES please let us know what type of display you'd like?
Our flower displays can be viewed at at Maillards Funerals
Large Spray BouquetCross WreathRose and Marigold BouquetCircle WreathCushion WreathHeart WreathWordsOther - bespoke

If you answered OTHER - BESPOKE in question 36 please expand further.

Please state who you are happy to receive flowers from?
Family onlyFriends onlyNo flowersEveryoneFriends and Family only

Would you like donations made in your memory as well as flowers? If yes, which charity/ies?

Additional Information

Would you like a quote for the above?
YesNoUndecided

Thank you for submitting your lasting wishes. A member of the Maillards team will be in touch.

Julian De La Cour
On behalf of Maillards Funeral Directors

“Preparing your lasting wishes can be difficult and often emotional, but Maillards are here to help you at every step of the way. Completing your lasting wishes with Maillards is a non-formal way for your executor to understand your preferences.”