Isle of Wight Council

MEMORIAL VASE AND TABLET APPLICATION FORM

	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.
	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

Name of applicant

Address details

*	Building/house name/number
*	Street address
*	Town Name
	County
*	Postcode
	Tel Number (include area code)
	Mobile Tel Number
	Email address
	Name of deceased
	Plot required

INSCRIPTION FOR VASE BLOCK TABLET

	Line 1
	Line 2
	Line 3
	Line 4
	Line 5
	Line 6

In order to ensure that an inscription will fit onto the granite tablet, please note the following information: If you are filling in this form on-line, the boxes above will allow a maximum of 20 characters each but you should note the restrictions below: 1. The person's name uses a larger typeface than the remainder of the inscription therefore it must not exceed more than 15 letters and/or spaces per line. 2. Lines not used for names may have a maximum of 20 smaller letters and/or spaces. 3. A maximum of 2 lines should be used for names. If a third line is required for names line 6 may not be used. 4. Do not forget to include the spaces in your inscription. A space counts as a letter or number. 5. We will centre the text on the tablet. 6. The inscription must be clearly written in block capitals. We are unable to accept responsibility for any incorrect inscription due to illegible or ambiguous writing if you are submitting a handwritten form.

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

FOR OFFICE USE ONLY

	Receipt number/Date .....................................................................
	Order number/date .........................................................................

	Delivered: .................................	Fixed:...............................................
	Informed Applicant (Letter/Phone)	.............................................................
	No of vase:.......................................	Renewal date:........................................
	Renewal letter sent.......................................	Renewed/Not Renewed:...............................

	Product	Cost	VAT code	GL Code
	Memorial Vase and Tablet Fee	£496.00	AF	67850731002

Date printed: 08/03/2013