Application for Interment : Christchurch City Council

Next of kin details

First names (required)

Last name (required)

Email address

Phone number (required)

Relationship (required)

Address (required)

Suburb

City

Postal code

Deceased information

Title

First names

Last name

Address line 1 (house name / number) (required)

Address line 2

Suburb

City

Postal code

Occupation

Date of death

Place of death

Date of birth

Place of birth

Age

Years living in New Zealand

Gender (required)

Type of plot (required)

Is this a Returned Services Association:

Reg N°

Rank

Field of operation

Special instructions

Please email me a copy of this form

Email address (copy of form)

Application for Interment