Application for Cremation

 

This form is to be completed in full by the person applying for the cremation on behalf of the family. The application will be reviewed and verified by a Medical Referee before cremation approval is granted.

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Application for Cremation Form

Who is Filling Out This Form(Required)
Address(Required)
This is an application to Rotorua Lakes Council as the controlling authority of the Rotorua Crematorium to undertake the cremation of the body of:
Full name of Deceased(Required)
Deceased Usual Address(Required)
Sex(Required)
Are you the executor of the deceased?(Required)
Are you a relative of the deceased?(Required)
Have the near relatives* of the deceased been informed of the proposed cremation?(Required)
*NOTE: The term “near relative” as used in this form means: a) the spouse, civil union partner, or de facto partner of the deceased, but only if that person living together with the deceased immediately before the death; and b) a parent of the deceased; and c) any child of the deceased who is aged 16 years or over; and d) an other relative of the deceased who usually resided with him or her
If the application is not made by an executor, is there an executor of the deceased?(Required)
If there is an executor have they been informed of the proposed cremation?
To the best of your knowledge and belief has any near relative or executor of the deceased expressed any objection to the proposed cremation?(Required)
What was the date and hour of death?
DD slash MM slash YYYY
Time
:
Address
Do you know or have any reason to suspect that the death of the deceased was due, directly or indirectly to:
Violence(Required)
Poison(Required)
Privation or neglect(Required)
Illegal operation(Required)
Do you know for any reason whatever for supposing that an examination of the body of the deceased may be desirable?(Required)
Do you know or have you any reason to suspect that the body of the deceased contains a cardiac pacemaker or other battery operated biomechanical aid?(Required)
Was the deceased a member of a religious denomination whose tenets require the burning of the body to be carried out as a religious rite elsewhere than in an approved crematorium?(Required)
Consent(Required)

Witness Details

Witness Name
Witness Signature(Required)
Witness Address(Required)