UK application form

Section A

Plan Holder Details

abbreviation A1:

Plan Holder

Name A1: *

Date A1: *

Date

Address A1: *

Address

Address A2: *

Post Code A1: *

Post Code

Tel A1: *

Tel

D.o.B A1: *

D.o.B

Place A1: *

Place of birth

Email a1:

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

abbreviation A2:

Plan Applicant

Name A2:

Date A2:

Date

Address A3:

Address

Address A4:

Post Code A2:

Post Code

Email a2:

Tel A2:

Tel

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

YES

Section B

Important contact Information

Plan Holder's Executors are b1:

Plan Holders Executor's are

Tel b1:

Tel

Address b1:

Address

Section C

Funeral Services

Plan Holders funeral directors are C1:

Plan Holder's funeral directors

Tel C1:

Tel

Address C1:

Address

Service to be held at C1:

Service to be held at

Religion C1:

Religion

Minister to officiate C1:

Minister to officiate

Tel C2:

Tel

Hymn C1:

Hymns / Readings at service

Hymn C2:

Hymn C3:

Hymn C4:

Cremation / Burial at C1:

Cremation / Burial at

Tel C3:

Tel

Grave No. C1:

Grave No.

Plot C1:

Plot

Name of last person interred C1:

Name of last person interred

Burial date C1:

Burial date

Name of owner of the grave C1:

Name of owner of the grave

Memorial directions C1:

Memorial directions

Cremated remains Directions C1:

Cremated remains directions

Further Notes

Notes C1:

Notes C2:

Notes C3:

Notes C4:

Notes C5:

Section D

Funeral Plan Details

Please tick D1:

Cremation

Burial

Please tick

Plan type

Please select

Please tick D2:

Plan type Cost D1:

Funeral Directors Extra Services D1:

Funeral Directors Extra Services

Extra Service Cost D1: £

Funeral Directors Extra Services D2:

Extra Service Cost D2: £

Funeral Directors Extra Services D3:

Extra Service Cost D3: £

Funeral Directors Extra Services D4:

Extra Service Cost D4: £

Funeral Directors Extra Services D5:

Extra Service Cost D5: £

Funeral Directors Extra Services D6:

Extra Service Cost D6: £

Funeral Directors Extra Services D7:

Extra Service Cost D7: £

Funeral Directors Extra Services D8:

Extra Service Cost D8: £

Funeral Directors Extra Services D9:

Extra Service Cost D9: £

Funeral Directors Extra Services D10:

Extra Service Cost D10: £

For example: costs of religious service, interment of ashes, local or regional difference in cemetery or crematorium fees.

Contributions towards Disbursements D1:

Contributions towards Disbursements

Disbursements Cost D1: £

Contributions towards Disbursements D2:

Disbursements Cost D2: £

Contributions towards Disbursements D3:

Disbursements Cost D3: £

Contributions towards Disbursements D4:

Disbursements Cost D4: £

Plan Administration Fee D1:

Plan Administration Cost D1: £

Totals Cost D1: £

Total

Further Notes D1:

Further Notes

Further Notes D2:

Further Notes D3:

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

UK application form

Pre-paid Funeral Plans

International Services

About Us