Isle of Wight Council

	Application for Burial Tablet at the Crematorium
	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.
	Isle of Wight Crematorium Station Lane Whippingham Isle of Wight PO32 6NJ Tel: 01983 882288
	Applicant Details

*	Forename
	Middle name/Initials
*	Surname

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

*	Name of deceased
*	Date of death

*

Inscription on the tablet (please select)

In Remembrance of In Loving Memory of

*	Inscription on the tablet
	Please note: Tablets cannot have the inscription changed if a mistake is made. A replacement tablet at full cost will be needed, in addition to the cost of the original tablet. Flowers, pot plants and any other tribute will not be permitted. These items will be removed.

	If you wish to have two inscriptions (side by side) on the same tablet, or wish to leave a space for a further name to be added at a later date please tick here
	Adult Burial Tablet £501.00 The price includes 'In Remembrance of' or 'In Loving Memory of' and the first 25 letters of the inscription. Any additional letters are charged at �2.50 per letter up to a maximum of 100 letters in total. First Burial is included, there will be a fee for any additional burial or inscription.  Extra letters Please tick if your inscription is more than 25 letters Please enter the  number of extra letters  , £4.00each

Please sign that the inscription is correct

Signed.............................................................. Name................................................................ Date..................................................................

	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

	Product	Cost	VAT code	GL Code
	Adult Burial Tablet Fee	£501.00	AF	67850731002
	Extra letter (Adult Burial Tablet)	£4.00	AF	67850731002

Date printed: 08/03/2013