(AFS) 2026 Application for Permission for Cremation

Application for Permission for Cremation

(Other than Still-Born Children)with statutory declaration Public Health Regulation, 2022 Section 104(1)(This form should be completed by an executor of the estate of the deceased, or nearest surviving relative of the deceased, or other proper person, and all questions must be fully answered)
(This form should be completed by an executor of the estate of the deceased, or nearest surviving relative of the deceased, or other proper person, and all questions must be fully answered)
I,
Full name of applicant
, of
Applicants address
Postcode
Postcode
Age
Your age today
Hereby apply for permission to cremate the remains of the late
Name of Deceased
of
Last address of deceased
Name of Crematorium
Location of Crematorium
State the deceased’s: (i) Marital Status
(ii) Age
(iii) Sex
(iv) Occupation
1.(a) Are you the nearest surviving relative of the deceased? If so, state relationship
(b)Are you an executor of the deceased’s estate?
(c) If neither an executor nor nearest surviving relative, state EITHER
(i)relationship to deceased
(ii)reason(s) why this application is being made by you
(iii)written authority for making this application
Complete the following statement:
I have been requested by
the deceased’s
(Relationship to deceased)
and his/her next of kin, to make this application of cremation and I am fully aware of the information contained herein.
(c)(i) Have all near relatives of the deceased been informed of the proposed cremation?
(ii) Has any near relative of the deceased expressed any objection to the cremation?
If so, state the reasons for objection
2.(a) Did the deceased leave any written directions as to mode of disposal of the remains
(b)If yes, what directions?
(c)Are you satisfied that the directions of the deceased were made in a state of sound mind?
3.When did the deceased die? (State date of death)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
4.Where did the death occur? (State address and location, i.e. own residence, hospital, nursing home, hotel, etc)
5.Do you know, or have you any reason to suspect, that the death of the deceased was due, directly, or indirectly, to:
Violence
Poison
Abuse or Neglect
Drowning
Suffocation
Burns
During Custodial Care
Illegal Operation
6. Have you any reason whatever for supposing that an examination of the remains of the deceased may be desirable/required by law?
7.Give the name and address of the usual attending medical practitioner of the deceased
9.Give the name of the Registry Office where the death has been, or is to be, registered
10.(a) Was any battery powered device E.g. pacemaker, attached to or present in the body of the deceased?
If yes, what kind of device?
(b)Has it been removed?
(c)If not, do you give permission for removal by an appropriately qualified person?
11. Has the deceased person ever received any radiopharmaceuticals or radioactive compounds? these are generally used for diagnostic and therapeutic purposes by many medical specialties.
I hereby certify that all particulars stated above are true and accurate, and that to the best of my knowledge and belief no particular material has been omitted; I therefore make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths Act 1900.
Signature
Declared at
Address of Place
On

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
(Applicant) in the presence of an authorised witness, who states:
I,
Name of Authorised Witness
Qualification of Authorised Witness
Certify the following matters concerning the making of this statutory declaration by the person who made itperson had a special justification for not removing the covering.
AND
Name and Type of Document
Signature of authorised witness
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
AgneeFS Reference Number
Crem Booking Number
Should be Empty: