Certification of Death (Scotland) Act 2011 Statutory Guidance

Annex C

Application under section 18(2) of the Certification of Death (Scotland) Act 2011

Section 1: the applicant

Full name of applicant:

Date of Birth of applicant:

Address of applicant:

Contact Details (Tel No/E-mail):

Are you the person arranging the funeral? Yes/No (please delete as applicable)

Do you have charge of the place where the funeral is taking place? Yes/No (please delete as applicable)

Date:

Section 2: Deceased details

Name of deceased:

Date of death:

Date of birth of deceased:

Country in which death occurred:

Place of death:

Section 3: Disposal arrangements

Is the deceased to be cremated in Scotland? Yes/No (please delete as applicable)

Where is the funeral to take place?

Date of funeral (if known at time of making application)

Do you wish to apply for post-mortem (if no cause of death)? Yes/no (please delete as applicable)

Section 4: Paperwork enclosed (please tick which applies):

Medical Certificate of Cause of Death (MCCD)/certificate of death in the country in which death occurred (or a copy if the original is not available)

Certificate of Registration of Death issued in the country in which death occurred (or a copy if the original is not available)

Passport/other ID of deceased

Hospital/ health records

Insurance company paperwork

Police report

Form A under the Cremation (Scotland) Regulations 1935

Other relevant information e.g. certificate declaring that death is not suspicious

Signature of funeral director (if applicable):

Date:

Declaration

This declaration should be completed and submitted with the

‘Application under section 18(2) of the Certification of Death (Scotland) Act 2011’

The applicant hereby certifies that to the best of their knowledge and belief the information contained within this application is correct and complete. The documents supplied are legitimate and have been verified by the applicant.

Signature of the applicant

(manual or electronic attestation):

Name of the applicant:

Date: