Fillable Cremation-Form-1-App-for-cremation-of-body-Apr-2018 Cremation 1: Application for cremation of the body of a person who has died

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Cremation-Form-1-App-for-cremation-of-body-Apr-2018 Cremation 1: Application for cremation of the body of a person who has died

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Application for cremation of the body
of a person who has died
Cremation 1
replacing Cremation 1
issued 2009
This form can only be completed by a person who is at least 16 years of age.
Please complete this form in full, if a part does not apply enter ‘N/A’.
Part 1 Details of the crematorium
Name of crematorium where cremation will take place
Name of funeral director Telephone number
Part 2 Your details (the applicant)
Your full name
Address Telephone number
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
Regulation 16(1)(a) of the Cremation (England and Wales) Regulations 2008
10.17
Email
South West Middlesex Crematorium
Age at date of death Sex
Part 3 continued
Male Female
Status
married/civil partnership widow/widower/surviving civil partner Single
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.
If No, please give the nature of your relationship and explain why you are
making the application rather than a near relative or an executor.
Yes No
2. Is there any near relative(s) or executor(s) who has not been informed of the
proposed cremation?
Yes No
If Yes, please give the name(s) and t he reason(s) why they have not been contacted.
3. Has any near relative or executor expressed any objection to the
proposed cremation?
Yes No
If Yes, please give details.
4. What was the date and time of death of the person who has died?
Date Time
/ /
Cremation 1 continued over the page ]
2
Part 4 continued
5. Please give the address where the person died.
Address
Please state whether it was the residence of the person who has died or a hotel, hospital, or
nursing home etc.
Their home Hospital Other (please specify)
Hotel Nursing home
6.
Do you know
or
suspect
that
the death of
the person who has
died was
violent or unnatural?
Yes No
7. Do you consider that there should be any further examination of the remains
of the person who has died?
Yes No
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?
Doctor’s name
Address Telephone number
Cremation 1 continued over the page ]
3
Part 4 continued
9. Please give the name, address and telephone number of the doctor(s) who attended the person who
has died during their last illness.
Doctor’s name
Address Telephone number
Doctor’s name
Address Telephone number
10. Was any implant placed in the body which may become hazardous when
Yes No
I don’t know
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 bef
ore cremation and some radioactive treatments may endanger the
health of crematorium staff.
If Yes, please give details and state whether it has been removed.
Cremation 1 continued over the page ]
4
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.
If certificates are given by medical practitioners:
I would like to inspect the certificates and
my contact telephone number is
I nominate
to inspect the certificates and their
contact
telephone number
is
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.
Option 1: Ashes to be scattered / interred / otherwise dealt with by the crematorium
Please give further details of your wishes here, from the options offered by the crematorium, for
instance where the ashes should be scattered / placed and when; and whether you wish this to be
witnessed.
Cremation 1 continued over the page ]
5
Cremation 1
6
Option 2: Ashes to be collected from the crematorium
Part 6 continued
Please give further details of your wishes here, such as who will collect the ashes (for instance you
and / or another family member, the funeral director, or another specified person); and by which
date, if known. The person collecting the ashes should bring a form of identification.
Option 3: Ashes to be held awaiting your decision
Please give further details of your wishes here, for instance where and for how long the ashes
should be held awaiting your decision.
When you have later made a decision, please confirm this, in writing with your signature, to your
funeral director or crematorium.
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 below to confirm that you understand this and that you wish to proceed
with the cremation.
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 wilfully make
a false statement with a view to obtaining the cremation of any human remains.
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Completed 4 July 2020

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