Cremation Permission Forms

Part 1: Details of the crematorium

Name of crematorium where cremation will take place

Name of funeral director

Telephone number

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Part 2: Your details (the applicant)

Your full name

Address

Telephone number

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Part 3: Details of the person who has died

Full name

Address

Occupation or last occupation if retired or not in work at date of death

Age at date of death

Sex
MaleFemale

Status
married/civil partnershipwidow/widower/surviving civil partnersingle

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Part 4: The application

1) Are you a near relative or an executor of the person who has died?

Near relative means the widow, widower or surviving civil partner of the person who has died, or a parent or child of the person who has died, or any other relative usually residing with the person who has died.
YesNo

2) Is there any near relative(s) or executor(s) who has not been informed of the proposed cremation?
YesNo

3 ) Has any near relative or executor expressed any objection to the proposed cremation?
YesNo

4) What was the date of death of the person who has died?

What was the time of death of the person who has died?

5) Please give the address where the person died.

Please state whether it was the residence of the person who has died or a hotel, hospital, or nursing home etc.
Their homeHospitalHotelNursing homeOther

6) Do you know or suspect that the death of the person who has died was violent or unnatural?
YesNo

7) Do you consider that there should be any further examination of the remains of the person who has died?
YesNo

If you have answered Yes to questions 6 or 7, please give reasons below.

8) What is the name, address, and telephone number of the usual doctor of the person who has died?

Doctors Name

Doctors Address

Doctors Telephone Number

9) Please give the name, address, and telephone number of the doctor(s) who attended the person who has died during their last illness.

Doctors Name

Doctors Address

Doctors Telephone Number

10) Was any implant placed in the body which may become hazardous when the body is cremated?

Was any implant placed in the body which may become hazardous when the body is cremated (e.g. a pacemaker, radioactive device, battery powered device or “Fixion” intramedullary nailing system)?

Implants may damage cremation equipment if not removed from the body of the deceased before cremation and some radioactive treatments may endanger the health of crematorium staff.
YesNoI don’t know

If Yes, please give details and state whether it has been removed.

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Part 5: Inspection of certificates

You are entitled to inspect the certificates (if any) given by doctors under regulation 16(1)(c)(i) of the Cremation (England and Wales) Regulations 2008 (forms Cremation 4 and Cremation 5). If you do not wish to inspect any such certificates yourself you may nominate another person to inspect them instead of you.

Such certificates will only be available for inspection at the offices of the cremation authority for 48 hours from the time that the cremation authority notifies you, or the person you have nominated, that the certificates are available to be inspected. You may take someone with you when you attend to inspect the certificates. If you, or the person nominated by you, do not attend to inspect the certificates at the time agreed with the cremation authority, the cremation may then proceed.

Please state if you would like to inspect the certificates given by the doctors or whether you would like to nominate someone else to do so instead and give a contact telephone number.

Would you like to inspect the certificates given by the doctors or nominate someone else to do so?
I do not wish to inspectI would like to inspectI nominate someone else

If you then your contact telephone number

If nominating someone else, provide their contact details

Nominee name

Nominee telephone number

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Part 6: Applicant’s instructions for ashes

Local practices regarding ashes vary and your funeral director or cremation authority will be able to advise you about these.

Please then tick the relevant box to confirm whether you have chosen Option 1, 2 or 3 below for the ashes following this cremation, and provide further details in the relevant free text box.

If you choose Option 1 or 2 you may alter your choice, confirmed in writing with your signature, before the cremation authority has made arrangements to implement your chosen option, so please advise your funeral director or the crematorium as soon as possible if you change your mind.

Please select an option for the ashes following the cremation:
Option 1: Ashes to be scattered / interred / otherwise dealt with by the crematoriumOption 2: Ashes to be collected from the crematoriumOption 3: Ashes to be held awaiting your decision

Provide further details based on your selection.

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Part 7: Recovery of ashes

Despite every effort being made to recover ashes following a cremation, on very rare occasions (particularly with a cremation of stillborn children) there may be no recoverable ashes. If you have any questions about this, please ask your funeral director or crematorium.

Please tick the box to confirm that you understand there may be no recoverable ashes in rare cases.
I understand and wish to proceed

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Part 8: Statement of truth

I apply for the body of the person who has died to be cremated and I certify that I am at least 16 years of age.
I believe that the facts given in this application are true. I am aware that it is an offence to willfully make a false statement with a view to obtaining the cremation of any human remains.

Print your full name

Signature

Date