Skip to content

Cremations NI

Pure & Simple - Direct Funerals

Home
About Cremations NI
Costs, Forms and Information
Payment
Application for Cremation
What is Direct Cremation?

Home
About Cremations NI
Costs, Forms and Information
Payment
Application for Cremation
What is Direct Cremation?

Application for Cremation

Client Details

Clients PrefixClients Prefix

Clients First Name *

Clients Last Name *

Clients Street Address *

Clients Town/City *

Clients Post Code *

Clients Country

Clients Phone *Mobile number if possible

Clients Email Address *

Clients Occupation *

Applicant For Cremation

This is the person who is responsible for making decisions regarding cremation (usually spouse, next of kin, or executor)

Applicants Prefix

Applicants First Name *

Applicants Middle Name/s

Applicants Last Name *

Applicants Street Address *

Applicants Town/City *

Applicants Post Code *

Applicants Country

Applicants Phone *

Applicants Occupation *

Deceased's Details

Deceased's Prefix

Deceased's First Name *

Deceased's Middle Name/s

Deceased's Last Name *

Deceased's Street Address *

Deceased's Town/City *

Deceased's Post Code *

Deceased's Country

Deceased's Occupation *

Date of Birth *

Day

Month

Year

Deceased's Age *0 / 3

Deceased's Sex *

Deceased's Marital Status *

Cremation Application Form

All questions must be answered (if not applicable please enter n/a)

RelationshipExecutorNearest RelativeNeitherAre you an executor or the nearest relative of the deceased

State Relationship to deceased *

If you are not an executor or nearest relative please state your relationship to the deceased and why the application is being made by you *

Did the deceased leave any written directions as to the mode of disposal (ie Burial or cremation) *NoYes

If yes, What were the written directions *

Have the near relatives of the deceased been informed of the proposed cremation *YesNo

If No, why have they not been informed *

Has any near relative of the deceased expressed any objection to the proposed cremation? *NoYes

If so on what ground? *

What date did the deceased die *

Day

Month

Year

What hour did the deceased die *

Address where the deceased died *

Town/City *

Post Code *

Type of place *

Do you know or have any reason to suspece that the death of the deceased was due directly or indirectly to (a) violence or misadventure (b) unfair means (c) negligence or misconduct (d) malpractice on the part of others (e) any cause other than natural illness or disease *NoYes

If Yes, give your reasons *

Do you know or have any reason to suspect that the death occurred while under anaesthetic? *NoYes

Do you know any reason whatever that an examination of the remains may be desirable? *NoYes(Request a post mortum examination)

Did the deceased have a pacemaker or any other radio-active or hazardous device fitted (eg Fixion intramedullary nailing system) *NoYesUnsure

Name and address of the Ordinary Medical Attendant (usually GP) *

Name and address of the Medical Practitioners who attended the last illness *

Has the death been registered?

-

Registration has not been completed - The death must be registered in NI within 5 days - once registered please email the GRO21 form to us; hello@cremationsni.co.uk

-

Registration has been completed - Please email the GRO21 form to us; hello@cremationsni.co.uk

Was the coroner involved with the death? *

Acceptance of Terms & Conditions *Please enter your name as acceptance of the Terms & Conditions

Save as Draft

Please do not fill in this field.

Developed by Think Up Themes Ltd. Powered by WordPress.