Request for Burial

This form can be used by relatives or by a Funeral Director to make arrangements for a burial, burial of ashes or scattering of ashes.
* indicates required information

Person making this request

Role: Funeral Director Relative: Relationship to deceased: *
Title: * If you are a relative
Forename(s): * Business Name: *
Surname: * If you are a Funeral Director
Address line 1: *
Address line 2:
Town/City: *
County: *
Postcode: *
Phone: *
Mobile Phone:
Email: *

Details of deceased and requested arrangements

Please give the following details of the deceased person. The address should be their last residential address, e.g. not a hospital address.

Forename(s): * Sex: Male Female
Surname: *
Address line 1: *
Address line 2:
Town/City: *
County: *
Postcode: *
Date of death: * Age: * years weeks (if under 1 year)
Type of interment: Burial Burial of ashes Scattering of ashes
Proposed date: * Proposed time: * :
 
Is the deceased an existing member? Yes No   If not we will ask for more information later and advise fee payable.
 
Complete this shaded section only if the deceased has already paid for burial rights and is an existing member of the Association.
Membership certificate number: If you do not know this, enter 'Not Known' or call us.
If the membership does not include a memorial tree (see certificate or call us), do you want to add one for an additional fee of £50.00?
Yes No   If you decide to add a tree, you will be able to choose a variety later.
 
Grave digger:   Grave-digger's Phone:
If you leave blank, we will arrange for a local grave digger to contact you. You, or your Funeral Director, must pay him directly. If you prefer to make your own arrangements, please give us your grave-digger's name and phone number so we can liaise and advise the allocated location.
Minister: If applicable. We serve both religious and secular burials.
Burial in reserved plot alongside:
If applicable, give full name of previously interred person.
Do you want to reserve adjacent plots? No Yes     If yes, you will need to apply for additional Memberships within 4 weeks.
Memorials: We do not permit the erection of headstones but encourage families to place an engraved slate plaque at the head of the grave or adjacent to memorial trees. These are not included in our charges and you will need to pay the supplier directly. Please see our guidelines.
We prefer to send you future communications by email. I am happy to receive communications by email OR please send by post
If the deceased is not a member, or I have added a memorial tree, I will pay the fee by: Cheque OR Bank transfer

By sending this form you confirm that you accept our Membership Rules which you can read here and consent to us holding the personal data you have given above about yourself and the deceased.
When you click SEND, we will give you further instructions.

I have read and accept the Membership Rules and consent to my personal data being held: (please click this box)