Isle of Wight Council

	To the Isle of Wight Council, Being the Burial Authority for the Isle of Wight
	APPLICATION FOR SCATTERING CREMATED REMAINS
	If not submitting on-line, this Notice is to be delivered between the hours of 9.00 am and 5.00 pm to The Bereavement Services Officer, Isle of Wight Crematorium, Whippingham, East Cowes, Isle of Wight PO32 6NJ Telephone (01983) 882288 at least TWO clear days before the day of scattering, exclusive of Saturdays, Sundays and Bank Holidays when the offices are not open. PLEASE COMPLETE IN BLOCK CAPITALS All applicants must complete Parts A and B and then either Part C or D
	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.
	PART A
	Location Details

*	Cemetery
	Grave No
	Section
*	Day of Week
*	Date
*	Time

	Details of Deceased
	Surname of Deceased
	Full Forenames
	Date of Birth
	Date of Death
	Age at Death
	Occupation

Address of Deceased

	Building/house name/number
	Street address
	Town Name
	County
	Postcode

Address where death occurred (if different from above)

	Building/house name/number
	Street address
	Town Name
	County
	Postcode

Crematorium Details

	Name of Crematorium
	Street address
	Town Name
	County
	Postcode
	Telephone No

Name and Address of Witness (if any)

	Forename
	Surname
	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	Telephone No

Name of Minister (if any)

Name of person scattering cremated remains

	Foreame
	Surname
	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	Telephone No

PART B

*

Is the exclusive right of burial in such grave space to be purchased? (if yes, please ring cremetorium on 01983 882288 for assistance)

Yes No

PART C

	Is there a Memorial over the grave?	Yes No
	If 'Yes', please indicate type of memorial

PART D

If Exclusive Rights of Burial are not purchased for the Grave on which scattering is to take place, then permission of the Executor(s), or if there is no Executor, the 'Next of Kin' of the last interred must be obtained by the Applicant.

WE (Full Name(s))

	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	(please state relationship of the last named interred)

	DO HEREBY GRANT my/our full Consent for the cremated remains of the person named in Part A of this form to be scattered on such grave space named in Part A of the form. I/We confirm that I/We have obtained all necessary consents AND DO HEREBY indemnify the Council against all claims against the Council howsoever arising of this Consent. Normal signatures................................................................... Date....................................................
	Signature of Applicant:................................................................

	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	Telephone No
	Date

FOR OFFICE USE ONLY

	Grave Space No........................................	Register Entry No:...................................
	Receipt No:................................	Amount �.......................
	Grant No:.......................................	Date Received:............................. Purchased: YES/NO
	Order to Contractor:.....................................	Date:....................................
	Certified by Cemeteries and Records Officer	.................................................................

	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

Date printed: 08/03/2013