Application For Cremation Online / Cremation forms

I, (full name of applicant) *

Address *

Email address *

Occupation *

Apply to the crematorium authority of Hamilton Park Crematorium to undertake the cremation of the body of:

Full name of Deceased *

Address *

Occupation *

Age and gender *

Relationship status *

The true answers to the questions set out below are as follows:

1. Are you an executor of the deceased? Yes/No *

2. Are you a relative of the deceased? Yes/No (If so state the relationship) *

If you are not an executor of the deceased or near relative, state why this application is being made by you and not a executor or near relative *

3. Have the near relatives of the deceased been informed of the proposed cremation? Yes/No *

4. If the application is not made by an executor, is there an executor of the deceased? Yes/No *

If there is a executor has he or she been informed of the proposed cremation? Yes/No *

5. To the best of your knowledge and belief has any near relative or executor of the deceased expressed any objection to the proposed cremation ? Yes/No *

If so, on what ground? *

6. What, to the best of your knowledge and belief, was the date and hour of death of the deceased ? *

7. Where did the deceased die? ( Give address, and say whether own residence, lodging, hotel, hospital, nursing home etc) *

8. Do you know or have any reason to suspect that the death of the deceased was due, directly or indirectly, to-

a) Violence: Yes/No *

b) Poison: Yes/No *

c) Privation or neglect: Yes/No *

d) illegal operation: Yes/No *

9. Do you know any reason whatsoever for supporting that an examination of the body of the deceased may be desirable? Yes/No *

9.a Do you know or have you any reason to suspect that the body of the deceased contains a cardiac pacemaker or other biomechanical aid? Yes/No *

10. Give the name and address of the ordinary medical practitioner of the deceased: *

11. Give the names and addresses of all medical practitioners or nurse practitioners who attended the deceased during his or her last illness: *

12. Who were the persons (if any) present at the time of death? *

13. Was the deceased a member of a religious denomination that requite the burning of the body to be carried out as a religious rite elsewhere other than in an approved crematorium? Yes/No (if so give the name of which religious organisation) *

I hereby certify, with a view to procuring the cremation of the body of the above named deceased, that all particulars stated above are true, and that to the best of my knowledge and belief no material particular has been omitted

Date *

Electronic Signature *

I hereby consent to this electronic signature

Full name of applicant *

Witness (Name in full) *

Occupation: *

Address: *

Contact number for applicant: *

APPLICATION FOR CREMATION

Form A