Application for Interment

This form should be filled out and submitted electronically to the Parish Clerk at least five working days before the date of interment.

For more information regarding the Parish Council’s charges and conditions, please visit the Cemeteries page on this website and ensure that you complete all sections of this form with precision. Should you require assistance, feel free to reach out to the Parish Clerk during office hours, or submit a Contact Us form and we will respond promptly.

The Parish Clerk will receive your completed form and usually provide a response by the following working day.

Section 1.

The Funeral

Proposed Date of Interment *

TitleName of Officiant or Celebrant

First Name *

Last Name *

Arrival Time at Cemetery *

Hours

Minutes

AM/PM

Proposed Time of Service *

Hours

Minutes

AM/PM

Section 2.

Details of Deceased

Title

First Name *

Middle Name

Last Name *

Date of birth *

Date of death *

Age at last birthday *0 / 3

Last known occupation *0 / 50

Residency *Was the deceased person residing in a residential / nursing home?YesNo

Late residence *

Village/Town *

County *

Postcode *

Country *

Place of death *

Village/Town *

County *

Postcode *

Country *

Residential/Nursing home *

Village/Town *

County *

Postcode *

Country

Length of stay *0 / 3

Section 3.

The grave and burial details

Burial Site:New grave purchasedPre-purchased graveRe-opening of existing grave

Type of Grave:Ashes / Cremated remainsCoffin / Caskett

Plot NumberThis information is required if a reserved plot has been previously secured

NB: Metal Coffins/Caskets are not allowed. *Outside measurements of Coffin/Casket Size (cm) – L x D x W

Depth

TitleName of Officiant or Celebrant

First Name *

Last Name *

Address of the Personal Representative *

Village/Town *

County *

Postcode *

Country *

Section 4. Details of grave

Has a grave already been purchased? *YesNo

This information will be recorded in Statutory Registers and used to produce a Deed of Grant for Exclusive Rights of Burial

Is the Deed to be issued in the name of the applicant? *YesNo

PrefixName of the Personal Representative *

First Name *

Middle Name

Last Name *

Contact Number *0 / 14

Email Address *

Street Address *

City/Town/village *

County *

Postcode *

Country *

Relationship to the deceased

Grant of Exclusive right…

NB: Grant of ‘Exclusive Right of Burial‘ to be in the name of the personal representative:

If no, please complete the following details of who will be the registered deed owner

Name of Registered Deed Owner *

Section 5. Grave already purchased

Address of the Personal Representative *

Village/Town *

County *

Postcode *

Country *

Title

First Name

Last Name

Grave re-opening

If a grave is to be re-opened, please give the name/s of person/s and if possible, date of burial/s:

Title

First Name

Last Name

Date of Burial

Month

Day

Year

Prefix

First Name *

Last Name *

Date of Burial

Month

Day

Year

Grant of Exec Rights comment

Grant of Exclusive Right of Burial: A copy is to be emailed to the Parish Clerk when requested. If missing, the applicant should contact the clerk to discuss.

Plot NumberThis information is required if a reserved plot has been previously secured0 / 10

Particulars of monument to be removed – if applicable:Representatives must arrange for any monument/memorial to be removed prior to grave digging.

Order for removal issued to:State name of company instructed.

Section 6

Details of the person or company arranging the funeral

Title

First Name

Last Name

Address *Business or Personal Representative

Village/Town/City *

County *

Post Code *

Country *

Contact Number *This should be the best number to contact you during office hours.0 / 14

Email Address *

Confirm Email Address *

Add filesPlease upload either of the following documents: Certificate of Cremation, or The Registrars’ or Coroners’ certificate if applicable.

DECLARATION

Any personal data that you provide will be processed in accordance with current data protection laws. It will be used by Hockliffe Parish Council and our partners to deliver and improve services and fulfil our legal duties. We will not disclose any personal information to anyone else unless required or allowed to do so by law. Read more about how we use personal data in our Privacy Notice on our website: www.hockliffepc.org.uk

I have read the rules and regulations and hereby agree to be bound by them.

I understand that payment of all fees and charges due for the provision of burial services is my responsibility as the applicant

Electronic Signature *

For Office Use Only

For office use only

Interment Number:____________

Notes/ Comments:

Grant Number – 1:

Entry Number – 1:

Date grant sent – 1:

Grant Number – 2:

Entry Number – 2:

Date grant sent – 2:

Form reference:

HR/form1/Version 12/03/2026.

Number