Cremation Regulations 1954 - Form 6

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CREMATION ACT 1929
Cremation Regulations 1954
Form 6
(Reg. 11)
Application for Permit to Cremate
Applicant
Name
Address
Deceased
Name
Address
Date of birth
/
/
Male/
Female/
Unspecified
Marital status
Occupation
(*“Nearest surviving
Nearest surviving relative* (if known)
relative” is explained
Name
at the end of this
form.)
Relationship
Usual doctor
Name
Address
Doctor who attended deceased during his or her last illness
Name
Address
Instructions from
Did the deceased leave any written directions about how his or her remains were to be
deceased
dealt with?
No
Yes. Give details
Objections
Do you know of anyone who objects to the deceased’s remains being cremated?
No
Yes. Give details of that person
Name
Relationship to deceased
Address
Coroner
Has the Coroner conducted an investigation or inquest into the deceased’s death?
Yes
No
Unsure
Applicant’s
relationship to
Administrator of the deceased
deceased
Nearest surviving relative* of the deceased
(*“Nearest surviving
Other
relative” is explained
at the end of this
form.)
Amended 2016

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