Information About the Deceased

Title

 

Forename(s)

 

Surname

 

Sex

Male / Female

Date of Birth

 

Date of Death

 

Residential Address

 

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

Date

 

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