Application for a Perpetual Interment Right

Purpose of this application form

This application form should be completed by a consumer that seeks to acquire a perpetual interment right at a cemetery.

Form approved by Cemeteries & Crematoria NSW under subsection 56(2) of the Cemeteries and Crematoria Act 2013.

Is this application for:* - required

Burial Ash interment

Cemetery* - required

Is the applicant also the intended holder of the interment right?* - required

Yes No

Intended holder/s of Perpetual Interment Right/s

First Name* - required

Last Name* - required

Street Address* - required

Suburb* - required

State* - required

Postcode* - required

Phone Number* - required

Date of Birth* - required

Email Address* - required

Do you consent to Tamworth Regional Council updating their records with the information provided above?* - required

Next of Kin/Secondary Contact Nominated by holder of a Perpetual Interment Right

First Name* - required

Last Name* - required

Street Address* - required

Suburb* - required

State* - required

Postcode* - required

Phone Number* - required

Relationship to Holder* - required

Proof of Identity

Applicants must provide at least one original photo identification document. This may include a passport or licence issued under Australian law (driver's licence or other government-issued licence).

Please upload a copy of your Driver's Licence or other photo identification* - required

Privacy Declaration

Information collected on this form is held in accordance with Privacy and Personal Information Protection Act 1998. Personal information is collected for a lawful purpose that directly relates to our primary function of providing cemetery/cremation services in accordance with the Cemeteries and Crematoria Act 2013. We will not collect any more information than is necessary to fulfil these functions. Except as necessary to carry out these functions, we will not disclose your personal information to anyone without your consent unless legally required to do so. We will take all reasonable steps to protect the security of any personal information held, be it stored in electronic or hard copy format. You may request access to your personal information held by us, except in the circumstances set out in Part 2, Division 3 of the Privacy and Personal Information Protection Act 1998.

Acknowledgment/Declaration

I acknowledge that all terms and conditions of this perpetual interment right have been disclosed and explained to me.* - required

Mandatory field(s) marked with *