Regulation 16(1)(a) of the Cremation (England and Wales) Regulations 2008
Cremation 1 - replacing Form A
This form can only be completed by a person who is at least 16 years of age. Please
complete this form in full, if a part does not apply enter ‘N/A’.
Name of crematorium where cremation will take place:
SOUTH WEST MIDDLESEX CREMATORIUM
Name of funeral director
Your full name
Occupation or last occupation if retired, or not working at date of death
Age at date of death
Married / Civil partnership
Widow / Widower / Surviving civil partner
1. Are you a near relative or an executor of the person who has died?
Near relative means the widow, widower or surviving civil partner of the person
who has died, or a parent or child of the person who has died, or any other relative
usually residing with the person who has died, or a parent of a stillborn baby.
If No, please give the nature of your relationship and explain why you are making
the application rather than a near relative or an executor.
2. Is there any near relative(s) or executor(s) who has not been informed of the
If Yes, please give the name(s) and the reason(s) why they have not been contacted.
3. Has any near relative or executor expressed any objection to the proposed cremation?
If Yes, please give details.
4. What was the date and time of the death of the person who has died?
5. Please give the address where the person died.
Please state whether it was the residence of the person who has died or a hotel,
hospital or nursing home etc.
Other (please specify)
6. Do you know or suspect that the death of the person who has died was violent
7. Do you consider that there should be any further examination of the remains of
the person who has died?
If you have answered Yes to questions 6 or 7, please give reasons below.
8. What is the name, address and telephone number of the usual doctor of the person
who has died?
(1) Doctor's name
9. Please give the name, address and telephone number of the doctor(s) who attended
the person who has died during their last illness.
(1) Doctor's name
(2) Doctor's name
10. Was any implant placed in the body which may become hazardous when the body
is cremated (e.g. a pacemaker, radioactive device or “Fixion” intramedullary nailing
Implants may damage cremation equipment if not removed from the body of the deceased
before cremation and some radioactive treatments may endanger the health of crematorium
If Yes, please give details and state whether it has been removed.
You are entitled to inspect the certificates (if any) given by doctors under regulation
16[c][i] of the Cremation Regulations 2008 (forms Cremation 4 and Cremation 5).
If you do not wish to inspect any such certificates yourself you may nominate another
person to inspect them instead of you. Such certificates will only be available
for inspection for 48 hours from the time that the cremation authority
notifies you, or the person you have nominated, that the certificates are available
to be inspected. You may take someone with you when you attend to inspect the certificates.
If you, or the person nominated by you, do not attend to inspect the certificates
at the time agreed with the cremation authority, the cremation may then proceed.
Please state if you would like to inspect the certificates given by the doctors
or whether you would like to nominate someone else to do so instead and give a contact
If certificates are given by medical practitioners :-
I would like to inspect the certificates and my contact telephone number is
to inspect the certificates and their contact telephone number is
I apply for the body of the person who has died to be cremated and I certify that
I am at least 16 years of age. I believe that the facts given in this application
are true. I am aware that is an offence to wilfully make a false statement with
a view to obtaining the cremation of any human remains.
Print your full name