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 |
|