International Application Form

Section One

Plan Holder Details

Plan Holder

Date

Address

Tel.

Date of Birth

Place of birth

Spouse Name

Maiden

Date of Marriage

Place of Marriage

Fathers Name

Mothers Name

If Widow, date of death

If Divorced - Date

Place of death

If you are applying for a third party please complete details below:

Plan Applicant

Address

Tel.

Do you wish them to be notified of the funeral plan and the arrangements you have made?

Section Two

Important contact Information

Executors

Tel.

Address

My solicitors are

Tel.

Address

Doctors Name

Tel.

Address

Section Three

Funeral Services

Plan Type

£

Instalment Interest

£

Additional Options

£
£

Total

Plan Holders Funeral Directors

Tel. No

Address

Service at

Religion

Address

Crematorium/Cemetery

Tel. No

Directions for cremated remains

Further Notes

Section Four

It is ESSENTIAL that you have a Spanish Asset Will.

Please print this page of your application form and then click on the "Next Page" button.