Internment Application Form
Information About the Deceased
Title
Forename(s)
Surname
Sex Male / Female
Date of Birth
Residential Address
Date of Death
Place where death occurred
Information About the Next of Kin / Applicant / Personal Representative
Full Name
Address
Home Telephone
Mobile Telephone
Relationship to the Deceased
Interment Details
Type of Interment: Ashes / Burial
Preferred Date: Preferred Time:
Exclusive Rights of Burial
Have Exclusive Rights already been purchased
Yes / No - If yes, please provide details below
Name of Purchaser
Address of Purchaser
Cemetery: Bardney Cemetery, Horncastle Road
Part Number: Plot Number
Please provide further information regarding the plot location i.e. beside the grave of…., in the grave of….
Funeral Details
Location: Graveside / Church - please provide details
Funeral Director Company Name:
Funeral Director Contact Name
Funeral Director Telephone:
Funeral Director Email
SIGNED:
DATE:
PRINT NAME: