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Application/Request for Burial
Details of Deceased
Name*:
Address 1*:
Address 2:
Address 3:
Address 4:
Address 5:
Date of Death*:
Age*:
Sex*:
--Select--
Female
Male
Religious Status:
Marital Status*:
Relationship to Purchaser*:
Type of Burial*:
--Select--
Ashes
Coffin
Organ
Other
Undertaker Details
Contact Name*:
Company Name*:
Contact Number*:
Contact Email Address:
Grave Digger*:
Service Details (if applicable)
Date and Time:
Location:
Cemetery Details
Date and Time*:
Location*:
Purchaser Details
New Purchase*
Name:
Address 1:
Address 2:
Address 3:
Address 4:
Address 5:
Plot Details
Re-Opening / First Opening*:
--Select--
First Opening
Re-Opening
Plot No. / Cemetery:
Name of Last Interred:
Date of Last Interred: