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Planter Plaque and Posy Vase Application Form

Please Note:
This form can be submitted online with a card payment
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Planter Plaque and Posy Vase Application Form
* The giving of false information may result in registration being refused or revoked, and the local authority reserve the right to make such further enquiries arising out of this application as they may consider desirable.

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 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.

I understand the plaque will remain in position for 10 years, and that I may renew or relinquish the dedication after this time.
(Please tick to accept)

The Council reserves the right to amend as may be necessary, or to refuse any inscription which is considered unsuitable.

The fee is not refundable should the application be withdrawn or refused.

If not submitting on-line please return completed form to:

Isle of Wight Crematorium
Station Lane,
East Cowes,
Isle of Wight
PO32 6NJ
Telephone (01983) 882288 / Fax (01983) 883010
Applicant Details
Title other title
(please specify)
* Forename
Middle name/Initials
* Surname
* Building/house name/number
* Street address
* Town name
* Postcode
 Tel number
(include area code)
Email address

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