Fillable Cremation-Form-2-App-for-cremation-of-body-parts-April-2018 Cremation 2: Application for cremation of body parts

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Cremation-Form-2-App-for-cremation-of-body-parts-April-2018 Cremation 2: Application for cremation of body parts

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Application for cremation of body parts
Cremation 2
replacing Cremation 2
issued in 2009
Body parts means material consisting of, or including, human cells from
a deceased person or stillborn baby.
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’.
If your application is about a stillborn baby, replace the words ‘person who has died’
throughout this form with the words ‘stillborn baby’.
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
In the case of a stillborn baby who has not been given a name, in place of the name and
address insert a description sufficient to identify the baby.
Full name
Address
Regulation 19(a) of the Cremation (England and Wales) Regulations 2008
10.17
Email
South West Middlesex Crematorium
Cremation 2 continued over the page ]
2
Part 3 continued
Age at date of death Sex
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?
Yes No
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, or a parent of a stillborn baby.
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.
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 the 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.
Part 4 continued
4.
What was the date and place of the death or stillbirth?
Date Address
/ /
5.
Please give the name and address of the cemetery, churchyard or crematorium where the
body of the person who has died was buried or cremated.
Name of cemetery, churchyard or crematorium
Address
6.
Please give the date that the burial or cremation took place.
Date
/ /
7.
Please state whether the body parts were removed from the body of the person who
has died at a:
Coroner’s post-mortem examination Hospital post-mortem examination
Other (please specify)
Cremation 2 continued over the page ]
3
Part 4 continued
8.
Do you consider that there should be any further examination of the
remains of the person who has died?
Yes No
If Yes, please give reasons below.
Part 5 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.
Option 2: Ashes to be collected from the crematorium
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.
Cremation 2 continued over the page ]
4
Part 5 continued
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 6 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 7 Statement of truth
I apply for the following body parts of the person who has died to be cremated and I certify that
I am at least 16 years of age.
Specify body parts to be cremated.
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.
Print your full name
Signed Dated
/ /
Cremation 2
5
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Completed 4 July 2020

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