Town of Port Hedland
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Online Form - Application for New/Renewal of Funeral Director’s Licence

Applicant Details

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Have you ever been convicted of any offence, anywhere?

Director(s) Details

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Manager(s) Details

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Secretary Details

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Partners Details

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  1. I hereby certify that the Board’s standard requirements appropriate to this application as contained in the Policy for Licensing of Funeral Directors have been met.
  2. I agree to maintain Public Liability Insurance cover and Workers Compensation Insurance cover (where applicable) as a condition of my license.

A Copy Certificate of Currency of Third Party Insurance must be attached to this application

  1. I agree to provide details of these insurance policies annually.
  2. I am familiar with the Cemeteries Act and the Town of Port Hedland Cemeteries Local Law and agree to abide by the requirements as set out.
  3. Should these requirements not be met I understand that I am liable to incur penalties and/or the loss of my Funeral Directors Licence, subject to my right of appeal.

Capacity Of Applicant

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Insurance Details