Courtesy Form

Courtesy Form

IN ORDER TO BE PROCESSED THIS FORM MUST BE COMPLETED IN FULL AND RECEIVED NOT MORE THAN 2 MONTHS AFTER THE DATE OF THE EVENT. PLEASE SEND THIS FORM TO THE UNIT OFFICE VIA FAX (705) 742 8599 or EMAIL (office@pvncoecta.ca).

  • Date Format: MM slash DD slash YYYY
  • (i.e. name of deceased, location of funeral, length of illness, special award, etc.)
  • (and home phone number if there is to be a delivery)
  • In the case of a death in the member’s family, would they like a donation to a specific charity? If so, which charity? Please provide home address of member (above).