EACH INSCRIPTION LINE MAY ONLY CONTAIN A MAXIMUM OF
35 CHARACTERS (INCLUDING SPACES). BLOCK LETTERS PLEASE. For
all entries in the Book of Remembrance, the day and month is displayed at the
top of the page. If you wish the year of death to appear, this must
be included in the inscription.
When writing your entry, the first line must only be used for the name of the deceased.
The second is for dates and a short epitaph, if there is space.
Please choose the number of lines you require:
-- Please Choose --
5 lines floral
8 lines floral
5 lines badge
8 lines badge
8 lines Coat of Arms
Line 1: Surname and Forenames
Line 2: Inscription
The Board reserves the right to vary any inscription as may be found necessary or
to refuse an entry which is considered unsuitable. Verses or quotations will only
be accepted if from a recognised and approved source.
The entry is to be recorded in the Book of Remembrance under the following
DATE OF DEATH (or other date if required):
Details of person making this application (BLOCK LETTERS PLEASE):):
Fees (see price list)
CHEQUES PAYABLE TO
SOUTH WEST MIDDLESEX CREMATORIUM BOARD
HOUNSLOW ROAD, HANWORTH, FELTHAM, MIDDLESEX, TW13 5JH
Tel. 020 8894 9001 email@example.com
Office Use only