Application For Interment Authorisation

Full name *

Sex: *

Male

Female

Date of birth: *

Date of death: *

Age: *

Last known permanent address: *

Suburb/town: *

State: *

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 interment authorisation

Title: *

Given names: *

Surname: *

Address: *

Suburb/town: *

State: *

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: *

Consent of holder of right of interment

Are you the holder of the right of interment for the place of interment where the remains will be interred? *

Yes

No

Please provide the details of the holder of the right of interment, answer the questions below and where possible obtain the signature of the right of interment holder.

Title: *

Given names: *

Surname: *

Address: *

Suburb/town: *

State: *

Post code: *

Telephone

Home:

Work:

Mobile:

Has the holder of the right of interment been informed of this application? *

Yes

No

Please give reasons why the holder of the right of interment has not been informed of this application: *

Does the holder of the right of interment consent to this application? *

Yes

No

Signature of holder of right of interment:

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 ***

Application For Interment Authorisation

Applicant for interment authorisation

Consent of holder of right of interment

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