Town of Port Hedland
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Online Form - Application for Single Funeral Permit

Applicant Details

Title

Details About The Deceased

Personal Details

I hereby make application for a Single Funeral Permit to be issued in relation to the details above and in support of such application I declare as follows:

  1. That I have in my possession a Medical Certificate or coroner’s order
  2. I will complete a Certificate of Identification.
  3. I have permission to re-open the grave if required.
  4. That in the event of a Burial,
    1. I am the holder of the Grant of Right of Burial for the grave; or
    2. I shall produce to Council the written consent of the holder of the Grant of Right of Burial for me to exercise the Rights to bury the above named deceased person in the grave; or
    3. That without either of the above I will be liable and I indemnify Council from expenses or damages resulting from the exercise of such rights.
  5. That the deceased will be enclosed in a substantial coffin bearing the name of the deceased person stamped (or otherwise indelibly inscribed) in legible characters on a metal plate of the coffins lid. (Local Law 7.1.(c).

Dimentions

Backfill

6. That the vehicle used to transport the body and coffin within the cemetery is a suitable vehicle of the following description:


Details of Vehicle


7. In the event of a permit being issued I will comply with the Cemetery Local Laws of the Town of Port Hedland.

8. I agree to maintain Public Liability Insurance cover and Workers Compensation Insurance Cover (where applicable) as a condition of my permit.

Note: A copy of Certificate of Currency of Insurance to be submitted with this application, please attach it below.