Cremation 2 - replacing Form AA
Body parts means material consisting of, or including, human cells from a deceased
person or stillborn baby.
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’.
If your application is about a stillborn baby, replace the words ‘person who has
died’ throughout this form with the words ‘stillborn baby’.
Name of crematorium where cremation will take place:
SOUTH WEST MIDDLESEX CREMATORIUM
Name of funeral director
Your full name
In the case of a stillborn baby who has not been given a name, in place of the name
and address insert a description sufficient to identify the baby.
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 place of the death or stillbirth?
5. Please give the name and address of the cemetery, churchyard or crematorium where
the body of the person who has died was buried or cremated.
Name of cemetery, churchyard or crematorium
6. Please give the date that the burial or cremation took place.
7. Please state whether the body parts were removed from the body of the person
who has died at a:
Coroner's post-mortem examination
Hospital post-mortem examination
Other (please specify)
8. Do you consider that there should be any further examination of the remains of
the person who has died?
If Yes, please give reasons below.
I apply for the following body parts of the person who has died to be cremated and
I certify that I am at least 16 years of age.
Specify body parts to be cremated.
I believe that the facts given in this application are true. I am aware that it
is an offence to wilfully make a false statement with a view to obtaining the cremation
of any human remains.
Print your full name