Vital Statistics Form

Vital Statistics Registration Details

We invite you to complete this form so that our team at KORU can help you care for your deceased person.

This information is standard and requested by every funeral home following a death.

Thank you for entrusting us with this information.

Initial Contact Person Name *

Initial Contact Person Email *

Initial Contract Person Phone *

Please describe your connection to the person who will receive the after-death care (executor, spouse, adult child, adult grandchild, parent, adult sibling, other) *

After-Death Plans For:

Legal Name of Deceased *

First

Middle

Last

Full legal name as it appears on the Passport, Birth Certificate, or Canadian Citizenship Card.

Name at Birth *

Place of Death *

*Please include either the name and city of a facility, or the full address. If place of death is unknown, or unclear, please type, "unknown".

Date of Death *

Current Legal Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Is there a Will in place? *

Executor / Legal Representative Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Identification Documents (copy) *

Click or drag files to this area to upload. You can upload up to 4 files.

Please upload one copy of a valid Canadian Driver's License OR Canadian Passport OR a Provincial Government ID card belonging to the executor or legal next of kin (whichever is applicable)