Confirmatory medical certificate
replacing Form C
This form may only be completed by a registered medical practitioner of at least five years’
standing who is not either a relative of the deceased, the medical practitioner who issued the
medical certificate (form Cremation 4) or a relative or a partner or colleague in the same practice
or clinical team as the medical practitioner who issued that certificate.
‘Five years’ standing’ means a medical practitioner who has been a fully registered person within
the meaning of the Medical Act 1983 for at least five years and, if paragraph 10 of Schedule 1 to
the Medical Act 1983 (Amendment) Order 2002 (S.I. 2002/3135) has come into force, has held a
licence to practice for at least five years or since the coming into force of that paragraph.
Please complete this form in full, if a part does not apply enter ‘N/A’.
Part 1 Details of the deceased
Occupation or last occupation if retired or not in work at the date of death
Part 2 The report on the deceased
1. Have you questioned the medical practitioner who gave the Medical
Certificate ( form Cremation 4)?
If No, please give reasons.
Regulation 16(c)(i) of the Cremation (England and Wales) Regulations 2008