Application for Burial Tablet at the Crematorium

All fields marked with a * are required entries

Please Note:

This form can be submitted online with a card payment

YOU MUST BE LOGGED IN TO SAVE AND SUBMIT THIS FORM
You are not currently logged in to My Profile, however you may

Complete the form and obtain a printout at the end

If you log in you may

	Pre-populate certain details from your profile account
	Save your form at any time and complete it later
	Submit your form online with a card payment.

New users click here to , existing users click here to

Application for Burial Tablet at the Crematorium

	If not submitting on-line please return completed form to: Isle of Wight Crematorium Station Lane, Whippingham, East Cowes, Isle of Wight PO32 6NJ Telephone (01983) 882288 / Fax (01983) 883010
*	Please contact the crematorium on 01983 882288 if you would like any help filling in this form, or would like more information on the memorial options available. The fee is not refundable should the application be withdrawn or refused. Please Note – in the first six months after the date of cremation, only the person who applied for the cremation may purchase a memorial. If you are not the person who applied for the cremation and wish to purchase a memorial within the first six months you must provide the written consent of the person who applied for the cremation. Please tick this box to confirm you have read and accept the terms and conditions

Applicant Details

*	Building/house name/number
*	Street address
*	Town name
	County
*	Postcode
	Telephone number (include area code)
	Email address

Fields marked '*' are required entries.

Page 1 of 4

Help

P122013