Application for cremation authorisation Name of crematorium at which cremation is to take place: * Details of the deceased Title: * Given names: * Surname: * Sex: * Male Female Date of birth: * Date of death: * Age: * Last known permanent address: * Suburb/town: * State: * ACT NSW NT QLD SA TAS VIC WA Post code: * Religion, if any (please note this field is optional): Did the deceased have a spouse or domestic partner at the time of the deceased's death? * Yes No Applicant for cremation authorisation Please note it is important that you advise the cemetery trust of any changes to your contact details as the cemetery trust will use these details to contact you about the cremated remains in the future. Title: * Given names: * Surname: * Address: * Suburb/town: * State: * ACT NSW NT QLD SA TAS VIC WA Post code: * Telephone Home: Work: Mobile: Email: Signature of applicant: * Clear To sign the form above, use your computer mouse or laptop trackpad to draw your signature in the box. If you are using a touch-screen device simply write your signature in the box using your finger. Date: * *** Please note the form may take up to 60 seconds to submit - the loading animation may pause, please do not re-submit during this time *** If you are human, leave this field blank.