Where is your loved one resting now?
*
Please Select
Home
Nursing/Residential Home
Hospice
Hospital
Coroner
Completing this form does not notify us immediately. If your loved one is at home/nursing home or hospice Please call us to arrange collection : 02392 501128
What is the full name of the person who has died?
*
Mr
Mrs
Miss
Ms
Dr
Prefix
First Name
Middle Name
Last Name
Known as
Date of birth
-
Day
-
Month
Year
Date of death
*
-
Day
-
Month
Year
Where is your loved one currently resting?
*
Street Address
Street Address Line 2
City
County
Postal Code
Usual GP and surgery details
This is required for the cremation paperwork
What is the approximate height and weight of your loved one?
What is your name?
*
Mr
Mrs
Miss
Ms
Dr
Prefix
First Name
Surname
Relationship
E.g wife, husband, son, daugher
Contact number
-
Area Code
Phone Number
Mobile number
Please include any area code
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
County
Postal Code
Is there anything else we need to know?
Please let us know any further details, e.g pacemaker in situ, has jewellery on.
What will happen with the cremated remains?
*
Please Select
Return to me
Scatter at crematorium
Declaration
*
I have read and agree to the terms and conditions and privacy and cookies notice.
I understand that the option I have selected regarding the management of cremated remains will be undertaken by Ruby unless I advise them in writing prior to the cremation taking place.
Submit
Should be Empty: