Burial Application

Introduction

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Details of Deceased

Name*

Gender*

Male
Female
Undisclosed

Date of Birth:*

Age*

Occupation

Birthplace:*

Date of Death:*

Place of Death:*

Last Place of Residence:*

Select as Appropriate:*

Sudden Death
Coroner's Case
Not Applicable

Cause of Death:*

Funeral Details

Funeral Director*

Contact Number*

Burial Date*

Burial Time*

Funeral Starting Location*

Name of Celebrant/Minister Officiating at Grave*

Please upload Certificate of identification (or, if applicable, form from the funeral director in lieu)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Please upload Doctor’s certificate for burial or disposal of the dead body or coroner’s order for burial

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Grave Details

Reserved Grave*

YesNo

Grant of Right of Burial Number (if applicable)

Denominational Ground*

Coffin Size*

Date of Last Interment (if applicable)

Name of Last Interment (if applicable)

Declaration

To the best of my knowledge the answers given to the questions above are true.

I am*

The Executor of the Deceased
Nearest Surviving Relative of the Deceased
Other

Name*

Contact Number*

Email Address*

Address*

Name of signatory*

Date*

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