| What was your (the applicant's) relationship to the deceased? | Other | |
| My relationship to the deceased was | Manager | |
| Was the deceased part of a household that was receiving Assured Income for the Severely Handicapped (AISH) or Income Support? | No | |
| Was the deceased a minor? | No | |
| What was the deceased's marital status at time of death? | Married | |
| Did the deceased have any dependents? | No | |
| Was the deceased a sponsored immigrant? | Yes |