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- Green Burial
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Obit Submission Form
FAQs About Cremation
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Have questions about cremation?
Call 778-433-9344 to speak to a cremation expert.
Serving Greater Victoria and Duncan.

General Price List
Cremation & Burial Packages
- Green Burial
About Us
- Facilities
- Hours of Operation
Obituaries
Obituary Submission Form
FAQs
Contact Us
Merchandise

Vital Statistics Information

The information below is required by the British Columbia Vital Statistics Agency. Pacific Coast Cremation is a registrar for the British Columbia Vital Statistics Agency and will use the information to register the death and issue the death certificate(s).

Contact Person / Executor
First Name*
Middle Name
Last Name*
Address*
Street Address City Province Postal Code
Email*
Phone*
Cell Phone
Work Phone
Relationship to Deceased*
Vital Statistical Information of Deceased
First Name of Deceased*
Middle Name(s) of Deceased
Last Name of Deceased*
Gender*
Date of Birth*
MM slash DD slash YYYY
Place of Birth (city, province, country)*
Date of Death*
MM slash DD slash YYYY
Place of Death (address or name of institution)
Marital Status*
Name of Spouse (maiden, first middle)
Social Insurance Number
Personal Health Number (Care Card #)
Usual Occupation*
Kind of Business/Industry*
Deceased's Father's Full Name
Deceased's Father's Place of Birth

Province if in Canada or Country if outside Canada
Deceased's Mother's Name (maiden, first middle)
Deceased's Mother's Place of Birth

Province if in Canada or Country if outside Canada
Last Residence/Address of Deceased*
Street Address City Province Postal Code
Doctor / GP
People / Groups to Notify about Obituary
Name of Person / Group & Email Address
Use separate line for each entry.
One last question...
How did you hear about Pacific Coast Cremation?*
- Previous experience
- Referral from friend
- Internet Search with Google
- Internet Search with Other Search Engine
- Times Colonist Ad
- Goldstream Gazette Ad
- Sooke News Ad
- Metchosin Muse Ad
- Drove by location on Goldstream Avenue
- Yellow Pages
Please indicate where the referral came from
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

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Funeral and cremation costs can be very confusing. All our prices are clearly disclosed on our general price list and website.

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Vital Statistics Information

Contact Person / Executor

Vital Statistical Information of Deceased

People / Groups to Notify about Obituary

One last question...

Satisfaction Guarantee

No Hidden Fee Guarantee