Application to Reserve a
Cemetery Plot
Purchase of the Exclusive Right of Burial
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
Please complete one application form per reserved plot request
Applicant Details (owner of Exclusive Right of Burial)
Full name/s
Postal Address
Contact Phone
Mobile Phone
Person/s to be Interred (if different from above)
Full Name
Relationship to Applicant
Cemetery
Plot No
Block
Casket Plot
Ashes Plot
Cemetery and Plot Details
Email Address
For Ofce Use
Completed by Checked by Manager - Customer Services
Reservation no
Date entered
Purchase amount
Plot location/availability conrmed
NCS record updated
Map updated
Invoice no.
Date paid
Receipt no
Purchase Certicate Issued
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Purchase Certicate saved to DMS
and NCS record and copy attached
to application form
Applicant/s Signature
Date
I make application to Waitomo District Council to purchase the exclusive right of burial in perpetuity.
I understand that the plot must be paid in full before Waitomo District Council will uphold the reservation.
I understand that the fee payable for the plot does not include the interment fee.
Full Name
Relationship to Applicant
Applicant Declaration
Payment Details
Account to be sent to
(if different from above)
Funeral Director
Signature
Address
Note: Fees are to be paid in full before issuing the Plot Reservation Certicate
