Janazah/Funeral Vital Statistics – Manitoba Islamic Association

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Janazah/Funeral Vital Statistics

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Your Name

First

Last

Your Email

Name of decedent (full legal name)

First

Last

Maiden name of decedent (surname at birth)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of birth

Place of birth

Date of death

Place of death

Type of work (when employed)

Place of employment (prior to retirement)

Canadian Social Insurance Number (SIN)

Marital status

Name of spouse (if married/widowed)

Maiden name of spouse

Name of father

Birthplace of father

Name of mother

Birthplace of mother

Informant

Informant Name

First

Last

Informant Relationship

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Next of Kin

Next of kin name

First

Last

Relationship

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Burial Location

Glen Lawn Cemetary (455 Lagimodiere Blvd.)
Transcona Cemetary (5014 Dugald Rd.)

Funeral expenses will be paid by

Family
insurance
EI
Government

Any additional comments