Sch. 1 Form 1 amended by S.R. No. 114/2025 reg. 13.
FORM 1
Regulation 22
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for interment authorisationโBODILY REMAINS
The deceased person
Full name:
Sex: [*tick appropriate box]
๐ Male ๐ Female ๐ Other ๐ Don't know/prefer not to say
Date of birth:
Date of death:
Age:
Last known permanent street address:
Suburb/town/city: State: Postcode:
Religion if any (optional):
Did the deceased person have a spouse or domestic partner at the time of the deceased person's death? [*tick appropriate box]
๐ Yes ๐ No ๐ Don't know/prefer not to say
Was the deceased person an identified veteran? [*tick appropriate box]
๐ Yes ๐ No ๐ Don't know
Place of interment
Name of public cemetery:
Type of place of interment: [specify type, e.g. grave, vault, mausoleum crypt]
Location of place of interment: [specify the location, e.g. section, row, grave number or other geographical locator]
Type of interment: [*tick appropriate box]
๐ New ๐ Preโpurchased/preโneed ๐ Reโopen
Please answer this question if this will be the first interment in the place of intermentโhow many additional interments will be required?
[*tick appropriate box]
Details of the funeral director or the person arranging for the interment and the funeral service (if any):
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Type of coffin, casket, container or receptacle: [*tick appropriate box]
๏ฏ Coffin ๏ฏ Casket ๏ฏ Other: [describe container or receptacle]
Dimensions of coffin, casket, container or receptacle:
Length: Width: Depth:
Material of which coffin, casket, container or receptacle is constructed: []
specify, e.g. wood, metal
Services (if any) being conducted: [*tick appropriate box]
๐ Funeral service at a venue within the cemetery prior to interment
๐ Funeral service at a location outside the cemetery prior to arrival at the cemetery for interment
๐ Funeral service at the interment site
๐ No attendance at interment
Date and time of funeral service (if any):
Special requirements for the interment: [specify, e.g. witness backfill, shoring, shroud burial with backboard or without backboard]
Date and time of interment:
Other requirements:
Applicant's details
Full name of applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to deceased person:
Consent of holder(s) of right of interment
Is the applicant the holder of the right of interment for the place of interment where the bodily remains will be interred? [*tick appropriate box]
๐ Yes, the sole holder of the right of interment [proceed toInformation accompanying application]
๐ Yes, one of the holders of the right of interment
๐ No
Complete this section in respect of each holder of the right of interment (other than the applicant). Attach additional pages if necessary.
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to deceased person:
I consent to the application for interment authorisation.
Signature(s) of holder(s) of right of interment: Date:
Have all holders of the right of interment been informed of this application? [*tick appropriate box]
๐ Yes ๐ No
If no, give reasons why all holders of the right of interment have not been informed:
If yes, do all holders of the right of interment consent to this application? [*tick appropriate box]
๐ Yes ๐ No
Information accompanying application
The following document accompanies this application in accordance with section 116(3) of the Cemeteries and Crematoria Act 2003: [*tick appropriate box]
๐ notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996(notice of death by treating doctor)
๐ copy of order made by a coroner under section 47 of the Coroners Act 2008(coroner's order)
๐ if the deceased person died outside Victoria, a document corresponding to a notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996 from the jurisdiction where the deceased person died (notice of death by treating doctorโother jurisdiction)
๐ if the deceased person died outside Victoria, a document corresponding to an order made by a coroner under section 47 of the Coroners Act 2008 from the jurisdiction where the deceased person died (coroner's orderโother jurisdiction)
๐ notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996(notice of stillโbirth)
๐ if the stillโbirth occurred outside Victoria, a document corresponding to a notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996 from the jurisdiction where the stillโbirth occurred (notice of stillโbirthโother jurisdiction)
๐ statutory declaration made by the person arranging the interment stating that, owing to special circumstances, it is not possible to produce one of the documents referred to above.
WARNING
Under section 117 of the Cemeteries and Crematoria Act 2003 it is an offence to make a false statement in an application for an interment authorisation, punishable by a fine of up to 240 penalty units or 2 years imprisonment or both.
Signature of applicant: Date:
Sch. 1 Form 2 amended by S.R. No. 114/2025 reg. 14.
FORM 2
Regulation 23
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for interment approvalโinterment other than in a public cemetery
The deceased person
Full name:
Sex: [*tick appropriate box]
๐ Male ๐ Female ๐ Other ๐ Don't know/prefer not to say
Date of birth:
Date of death:
Age:
Last known permanent street address:
Suburb/town/city: State: Postcode:
Religion if any (optional):
Did the deceased person have a spouse or domestic partner at the time of the deceased person's death? [*tick appropriate box]
๐ Yes ๐ No ๐ Don't know/prefer not to say
Location of proposed place of interment
Property details: [specify address and Certificate of Title folio and volume reference, and if the interment is proposed to take place on Crown land, Crown allotment details]
Location of interment on land: [provide details consistent with the cemetery system for recording grave locations, e.g. section, row, grave number or other geographical locator]
Details of other interments at the proposed place of interment
Is there a record of another person having been buried on the land? [*tick appropriate box]
๐ Yes ๐ No
If no, contact the Department to discuss the application.
If yes, is the existing grave(s) clearly marked? [*tick appropriate box]
๐ Yes ๐ No
Provide details, such as existing headstones, fencing of grave, etc:
Interment and funeral arrangements
Details of funeral director or the person arranging for the interment and the funeral service (if any):
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Type of coffin, casket, container or receptacle: [*tick appropriate box]
๏ฏ Coffin ๏ฏ Casket ๏ฏ Other: [describe container or receptacle]
Dimensions of coffin, casket, receptacle or container if any:
Length: Width: Depth:
Material of which coffin, casket, container or receptacle is constructed: [specify, e.g. wood, metal]
Description of memorial or marker to be placed over the place of interment:
Applicant's details
Full name of applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to deceased person:
Consent of land owner/manager
Please obtain the consent of the applicable person listed below to the interment on the land:
Land ownerโattach a copy of the Certificate of Title confirming your ownership of the land and sign below indicating your consent to the interment on your land.
Signature of land owner: Date:
Appointed delegate of the land ownerโattach a copy of the Certificate of Title and a signed statement from the land owner indicating that you are authorised to act on their behalf in regard to conducting interments on their land. This statement must include the land owner's full name, address and contact telephone number.
Signature of delegate: Date:
Appointed land manager (relates to Crown land)โattach a statement from the body responsible for the management of that land that you are authorised to carry out the interment on the land.
(**Delete if not applicable.*)
Information accompanying application
The following document accompanies this application in accordance with section 121(3) of the Cemeteries and Crematoria Act 2003: [*tick appropriate box]
๐ notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996(notice of death by treating doctor)
๐ copy of order made by a coroner under section 47 of the Coroners Act 2008(coroner's order)
๐ if the deceased person died outside Victoria, a document corresponding to a notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996 from the jurisdiction where the deceased person died (notice of death by treating doctorโother jurisdiction)
๐ notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996(notice of stillโbirth)
๐ if the stillโbirth occurred outside Victoria, a document corresponding to a notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996 from the jurisdiction where the stillโbirth occurred (notice of stillโbirthโother jurisdiction)
๐ statutory declaration made by the person arranging the interment stating that, owing to special circumstances, it is not possible to produce one of the documents referred to above.
WARNING
Under section 122 of the Cemeteries and Crematoria Act 2003 it is an offence to make a false statement in an application for an interment approval, punishable by a fine of up to 240 penalty units or 2 years imprisonment or both.
Signature of applicant: Date:
Sch. 1 Form 3 amended by S.R. No. 114/2025 reg. 15.
FORM 3
Regulation 24
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for interment authorityโBODy parts (excluding foetal remains)
Prescribed information
The person supplying the information in this section must be a person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (e) of the Cemeteries and Crematoria Regulations 2025.
Full name of the person to whom the body parts belonged:
Description of the body parts to be interred:
Details of person supplying the prescribed information
Is the person supplying the prescribed information the applicant for interment authority? [*tick appropriate box]
๐ Yes ๐ No
If no, provide the details of person supplying the prescribed information:
Full name:
Entity name (if any): [e.g. hospital, school of anatomy, tissue bank]
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Select the class of prescribed person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (e) of the Cemeteries and Crematoria Regulations 2025 to which the person belongs: [*tick appropriate box]
๐ registered medical practitioner who treated the person to whom the body parts belonged
๐ registered medical practitioner of the hospital where the person to whom the body parts belonged was treated
๐ coroner
๐ inspector of a school of anatomy
๐ head of school of anatomy
๐ the Secretary
๐ authorised representative of a tissue bank
๐ the Victorian Institute of Forensic Medicine
Signature of person supplying prescribed information (if not the applicant):
Date:
Person to whom the body parts belonged
Sex: [*tick appropriate box]
๐ Male ๐ Female ๐ Other ๐ Don't know/prefer not to say
Date of birth:
Date of death (if applicable):
Last known permanent street address:
Suburb/town/city: State: Postcode:
Place of interment
Name of public cemetery:
Type of place of interment: [specify type, e.g. grave, vault, mausoleum crypt]
Location of place of interment: [specify the location, e.g. section, row, grave number or other geographical locator]
Type of interment: [*tick appropriate box]
๐ New ๐ Preโpurchased/preโneed ๐ Reโopen
Please answer this question if this will be the first interment in the place of intermentโhow many additional interments will be required? [*tick appropriate box]
Details of the funeral director or the person arranging for the interment and the funeral service (if any):
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Type of coffin, casket, container or receptacle: [*tick appropriate box]
๏ฏ Coffin ๏ฏ Casket ๏ฏ Other: [describe container or receptacle]
Dimensions of coffin, casket, container or receptacle:
Length: Width: Depth:
Material of which coffin, casket, container or receptacle is constructed: [specify, e.g. wood, metal]
Services (if any) being conducted: [*tick appropriate box]
๐ Funeral service at a venue within the cemetery prior to interment
๐ Funeral service at a location outside the cemetery prior to arrival at the cemetery for interment
๐ Funeral service at the interment site
๐ No attendance at interment
Date and time of funeral service (if any):
Special requirements for the interment: [specify, e.g. witness backfill, shoring, shroud burial with backboard or without backboard]
Date and time of interment:
Other requirements:
Applicant's details
Full name of applicant:
If applicant is not a natural person, the name of the contact person for the applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to the person to whom the body parts belonged:
Consent of holder(s) of right of interment
Is the applicant the holder of the right of interment for the place of interment where the body parts will be interred? [*tick appropriate box]
๐ Yes, the sole holder of the right of interment [Proceed to Signature of applicant]
๐ Yes, one of the holders of the right of interment
๐ No
Complete this section in respect of each holder of the right of interment (other than the applicant). Attach additional pages if necessary.
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to person to whom the body parts belonged:
I consent to the application for interment authority.
Signature(s) of holder(s) of right of interment: Date:
Have all holders of the right of interment been informed of this application? [*tick appropriate box]
๐ Yes ๐ No
If no, give reasons why all holders of the right of interment have not been informed:
If yes, do all holders of the right of interment consent to this application? [*tick appropriate box]
๐ Yes ๐ No
Signature of applicant: Date:
Sch. 1 Form 4 amended by S.R. No. 114/2025 reg. 16.
FORM 4
Regulation 25
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for interment authorityโfoetal remains which are not a stillโborn child
Prescribed information
The person supplying the information in this section must be a person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (f) of the Cemeteries and Crematoria Regulations 2025.
Full name of the person who was pregnant with the foetus:
Details of person supplying the prescribed information
Is the person supplying the prescribed information the applicant for interment authority? [*tick appropriate box]
๐ Yes ๐ No
If no, provide the details of person supplying the prescribed information:
Full name:
Entity name (if any): [e.g. hospital, school of anatomy, tissue bank]
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Select the class of prescribed person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (f) of the Cemeteries and Crematoria Regulations 2025 to which the person belongs: [*tick appropriate box]
๐ registered medical practitioner who treated the person who was pregnant with the foetus
๐ registered medical practitioner of the hospital where the person who was pregnant with the foetus was treated
๐ coroner
๐ inspector of a school of anatomy
๐ head of school of anatomy
๐ the Secretary
๐ authorised representative of a tissue bank
๐ the Victorian Institute of Forensic Medicine
๐ the person who was pregnant with the foetus
Signature of person supplying prescribed information (if not the applicant):
Date:
Place of interment
Name of public cemetery:
Type of place of interment: [specify type, e.g. grave, vault, mausoleum crypt]
Location of place of interment: [specify the location, e.g. section, row, grave number or other geographical locator]
Type of interment: [*tick appropriate box]
๐ New ๐ Preโpurchased/preโneed ๐ Reโopen
Please answer this question if this will be the first interment in the place of intermentโhow many additional interments will be required? [*tick appropriate box]
๐ Held at crematorium (for up to 12 months after the cremation)
Note: Cemetery trusts are required to hold the cremated remains for at least 12 months after the cremation. Following the expiry of the 12 month period, the cemetery trust may dispose of the cremated remains in any way that it considers appropriate.
๐ Other: [pleasespecify, e.g. to be posted, urgent collection within 24 hours]
Agent's details
If you would like to nominate an agent to collect the cremated remains, please provide the following details:
Full name of agent:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Statement by funeral director or person arranging the cremation
This section should be completed by the funeral director or the person who is arranging for the cremation of the bodily remains.
Please select one option:
๐ The deceased person has no pacemaker or batteryโpowered device.
๐ I have arranged for the deceased person's pacemaker or other batteryโpowered device to be removed.
๐ The deceased person's pacemaker or other batteryโpowered device has not been removed as the cemetery trust does not require its removal.
Signature of funeral director/person arranging cremation: Date:
Information accompanying application
The following document accompanies this application in accordance with section 131(3) of the Cemeteries and Crematoria Act 2003: [*tick appropriate box]
๐ a certificate of a registered medical practitioner authorising cremation (Form 6) together with a notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996(notice of death by treating doctor)
๐ copy of order made by a coroner under section 47 of the Coroners Act 2008(coroner's order)
๐ if the deceased person died outside Victoria, an authority to cremate under the hand of the coroner or other person permitted by the law of the jurisdiction where the deceased died (coroner's orderโother jurisdiction)
๐ notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996(notice of stillโbirth)
๐ if the stillโbirth occurred outside Victoria, a notice corresponding to a notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996 from the jurisdiction where the stillโbirth occurred (notice of stillโbirthโother jurisdiction)
๐ a cremation approval.
WARNING
Under section 132 of the Cemeteries and Crematoria Act 2003 it is an offence to make a false statement in an application for a cremation authorisation, punishable by a fine of up to 600 penalty units or 5 years imprisonment or both.
Signature of applicant: Date:
Form 6
Regulation 27
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Certificate of Registered Medical Practitioner Authorising Cremation
Note 1:
In accordance with section 138 of the Cemeteries and Crematoria Act 2003 this form must be signed by a registered medical practitioner who is not the registered medical practitioner who completed the notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996 in respect of the death of the deceased person who is to be cremated.
Note 2:
This form is not required for the cremation of a stillโborn child.
The deceased person
Full name:
Sex: [*tick appropriate box]
๐ Male ๐ Female ๐ Other ๐ Don't know/prefer not to say
Date of birth:
Date of death:
Place of death:
Certificate
I, [name of registered medical practitioner], of [address of registered medical practitioner], certify that:
I am a currently registered medical practitioner under the Health Practitioner Regulation National Law.
I have carefully read the statements contained in the Application for cremation authorisation relating to the deceased person, signed by [applicant for cremation authorisation] and dated [date of application for cremation authorisation].
I have examined the body of the deceased person.
I have sighted a completed notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996 in respect of the death of the deceased person who is to be cremated.
AND I state that:
I have made careful and independent inquiry into the circumstances surrounding the death of the deceased person.
I agree with the cause of death as shown on the notice given under section 37(2) of the Births, Deaths and Marriages Registration Act 1996.
In my opinion the death is not reportable or reviewable under the Coroners Act 2008.
In my opinion, there is no circumstance concerning the death of the deceased person that might necessitate further examination of the body before it is cremated, or which could, in my opinion, make exhumation of the body necessary at any time in the future.
In my opinion there is no reason why the cremation should not proceed.
Apart from any fee payable for the provision of this certificate, I have not acquired and do not anticipate acquiring directly or indirectly any property or pecuniary or other benefit of any description by reason of the death of the deceased person.
I am not in partnership with, nor will I derive any professional remuneration from, any registered medical practitioner who professionally attended the deceased person.
*I authorise the cremation of the deceased person.
*I refuse to authorise the cremation of the deceased person on the grounds that: [specifyreasons]
(*Delete if not applicable.)
Full name:
Street Address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Medical practitioner registration number:
WARNING
Under section 140 of the Cemeteries and Crematoria Act 2003 it is an offence to make a false statement in a certificate of a registered medical practitioner authorising cremation, punishable by a fine of up to 600 penalty units or 5 years imprisonment or both.
Signature of medical practitioner: Date:
Sch. 1 Form 7 amended by S.R. No. 114/2025 reg. 18.
Form 7
Regulation 28
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for Cremation authorityโbody parts (EXCLUDING foetal remains)
Prescribed information
The person supplying the information in this section must be a person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (e) of the Cemeteries and Crematoria Regulations 2025.
Full name of the person to whom the body parts belonged:
Description of the body parts to be cremated:
Details of person supplying the prescribed information
Is the person supplying the prescribed information the applicant for cremation authority? [*tick appropriate box]
๐ Yes ๐ No
If no, provide the details of person supplying the prescribed information:
Full name:
Entity name (if any): [e.g. hospital, school of anatomy, tissue bank]
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Select the class of prescribed person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (e) of the Cemeteries and Crematoria Regulations 2025 to which the person belongs: [*tick appropriate box]
๐ registered medical practitioner who treated the person to whom the body parts belonged
๐ registered medical practitioner of the hospital where the person to whom the body parts belonged was treated
๐ coroner
๐ inspector of a school of anatomy
๐ head of school of anatomy
๐ the Secretary
๐ authorised representative of a tissue bank
๐ the Victorian Institute of Forensic Medicine
Signature of person supplying prescribed information (if not the applicant):
Date:
Person to whom the body parts belonged
Sex: [*tick appropriate box]
๐ Male ๐ Female ๐ Other ๐ Don't know/prefer not to say
Date of birth:
Date of death (if applicable):
Last known permanent street address:
Suburb/town/city: State: Postcode:
Place of cremation
Name of crematorium:
Cremation and funeral arrangements
Details of the funeral director or the person arranging for the cremation and the funeral service (if any):
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Type of coffin, casket, container or receptacle: [*tick appropriate box]
๏ฏ Coffin ๏ฏ Casket ๏ฏ Other: [describe container or receptacle]
Dimensions of coffin, casket, container or receptacle:
Length: Width: Depth:
Material of which coffin, casket, container or receptacle is constructed: [specify, e.g. wood]
Services (if any) being conducted: [**tick appropriate box(es)*]
๐ Funeral service at a venue within the cemetery prior to cremation
๐ Funeral service at a location outside the cemetery prior to arrival at the cemetery for cremation
๐ Funeral service at the crematorium to witness the commencement of the cremation
๐ Viewing at the crematorium prior to the cremation
๐ No funeral service prior to cremation (no attendance)
Date and time of funeral service (if any):
Date and time of cremation:
Cultural requirements post cremation (e.g. bone sort):
Other requirements:
Applicant's details
Full name of applicant:
If the applicant is not a natural person, the name of the contact person for the applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to the person to whom the body parts belonged:
Cremated remains
Following cremation, the cremated remains are to be: [**tick appropriate box(es)*]
๐ Interred at: [specify cemetery]
Note: The cemetery trust must authorise the interment of cremated human remains: see section 141 of the Cemeteries and Crematoria Act 2003.
๐ Held at crematorium (for up to 12 months after the cremation)
Note: Cemetery trusts are required to hold the cremated remains for at least 12 months after the cremation. Following the expiry of the 12 month period, the cemetery trust may dispose of the cremated remains in any way that it considers appropriate.
๐ Other: [pleasespecify, e.g. to be posted, urgent collection within 24 hours]
Agent's details
If you would like to nominate an agent to collect the cremated remains, please provide the following details:
Full name of agent:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Statement by funeral director or person arranging the cremation
This section is to be completed by the funeral director or the person who is arranging for the cremation of the body parts.
Please select one option:
๐ The body parts contain no pacemaker or batteryโpowered device.
๐ I have arranged for the pacemaker or other batteryโpowered device to be removed from the body parts.
๐ The pacemaker or other batteryโpowered device has not been removed from the body parts as this is not required by the cemetery trust.
Signature of funeral director/person arranging cremation: Date:
Signature of applicant: Date:
Sch. 1 Form 8 amended by S.R. No. 114/2025 reg. 19.
Form 8
Regulation 29
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for Cremation Authorityโfoetal remains which are not a stillโborn child
Prescribed information
The person supplying the information in this section must be a person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (f) of the Cemeteries and Crematoria Regulations 2025.
Full name of the person who was pregnant with the foetus:
Details of person supplying the prescribed information
Is the person supplying the prescribed information the applicant for cremation authority? [*tick appropriate box]
๐ Yes ๐ No
If no, provide the details of person supplying the prescribed information:
Full name:
Entity name (if any): [e.g. hospital, school of anatomy, tissue bank]
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Select the class of prescribed person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (f) of the Cemeteries and Crematoria Regulations 2025 to which the person belongs: [*tick appropriate box]
๐ registered medical practitioner who treated the person who was pregnant with the foetus
๐ registered medical practitioner of the hospital where the person who was pregnant with the foetus was treated
๐ coroner
๐ inspector of a school of anatomy
๐ head of school of anatomy
๐ the Secretary
๐ authorised representative of a tissue bank
๐ the Victorian Institute of Forensic Medicine
๐ the person who was pregnant with the foetus
Signature of person supplying prescribed information (if not the applicant):
Date:
Place of cremation
Name of crematorium:
Cremation and funeral arrangements
Details of the funeral director or the person arranging for the cremation and the funeral service (if any):
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Type of coffin, casket, container or receptacle: [*tick appropriate box]
๏ฏ Coffin ๏ฏ Casket ๏ฏ Other: [describe container or receptacle]
Dimensions of coffin, casket, container or receptacle:
Length: Width: Depth:
Material of which coffin, casket, container or receptacle is constructed: [specify, e.g. wood]
Services (if any) being conducted: [**tick appropriate box(es)*]
๐ Funeral service at a venue within the cemetery prior to cremation
๐ Funeral service at a location outside the cemetery prior to arrival at the cemetery for cremation
๐ Funeral service at the crematorium to witness the commencement of the cremation
๐ Viewing at the crematorium prior to the cremation
๐ No funeral service prior to cremation (no attendance)
Date and time of funeral service (if any):
Date and time of cremation:
Additional information regarding the foetal remains (optional):
Cultural requirements post cremation (e.g. bone sort):
Other requirements:
Applicant's details
Full name of applicant:
If the applicant is not a natural person, the name of the contact person for the applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Cremated remains
Following cremation, the cremated remains are to be: [**tick appropriate box(es)*]
๐ Interred at: [specify cemetery]
Note: The cemetery trust must authorise the interment of cremated human remains: see section 141 of the Cemeteries and Crematoria Act 2003.
๐ Held at crematorium (for up to 12 months after the cremation)
Note: Cemetery trusts are required to hold the cremated remains for at least 12 months after the cremation. Following the expiry of the 12 month period, the cemetery trust may dispose of the cremated remains in any way that it considers appropriate.
๐ Other: [pleasespecify, e.g. to be posted, urgent collection within 24 hours]
Agent's details
If you would like to nominate an agent to collect the cremated remains, please provide the following details:
Full name of agent:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Signature of applicant: Date:
Form 9
Regulation 30
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for Cremation authorisationโ
bodily remains with an identifier
The deceased person
Identifier assigned to the deceased person:
Description of the bodily remains:
Place of cremation
Name of crematorium:
Applicant's details
Name of applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Contact person for the applicant (if relevant):
Details of funeral director or person arranging for the cremation
Is the applicant arranging for the cremation of the bodily remains? [*tick appropriate box]
๐ Yes ๐ No
If yes, proceed to Cremated remains.
If no, provide details below of the funeral director or person arranging the cremation of the bodily remains on behalf of the applicant.
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Cremated remains
Following cremation, the cremated remains are to be: [*tick appropriate box]
๐ Interred at: [specify cemetery]
Note: The cemetery trust must authorise the interment of cremated human remains: see section 141 of the Cemeteries and Crematoria Act 2003.
๐ Other: [please specify]
Type of place of interment: [specify type, e.g. grave, vault, mausoleum crypt, wall niche, memorial plant, garden bed, lawn or plot]
Location of place of interment: [specify the location, e.g. section, row, grave number or other geographical locator]
Date of cremation:
Statement by funeral director or person arranging the cremation
This section is to be completed by the funeral director or the person who is arranging for the cremation of the bodily remains.
Please select one option:
๐ The deceased person has no pacemaker or batteryโpowered device.
๐ I have arranged for the deceased person's pacemaker or other batteryโpowered device to be removed.
๐ The deceased person's pacemaker or other batteryโpowered device has not been removed as the cemetery trust does not require its removal.
Signature of funeral director/person arranging cremation: Date:
WARNING
Under section 132 of the Cemeteries and Crematoria Act 2003 it is an offence to make a false statement in an application for a cremation authorisation, punishable by a fine of up to 600 penalty units or 5 years imprisonment or both.
Signature of applicant: Date:
Form 10
Regulation 31
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application for Cremation authorityโbody parts with an identifier OR CONTAINER REFERENCE NUMBER
Prescribed information
The person supplying the information in this section must be a person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (f) of the Cemeteries and Crematoria Regulations 2025.
Body parts
Identifier or container reference number for the body parts:
Description of the body parts to be cremated:
Note: The applicant should keep a record of the identifiers for all body parts and the names (if known) of the persons to whom the body parts belonged within a container.
Details of person supplying the prescribed information
Is the person supplying the prescribed information the applicant for cremation authority? [*tick appropriate box]
๐ Yes ๐ No
If no, provide the details of person supplying the prescribed information:
Full name:
Entity name (if any): [e.g. hospital, school of anatomy, tissue bank]
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Select the class of prescribed person listed in section 151(3)(a) to (c) of the Cemeteries and Crematoria Act 2003 or regulation 21(a) to (f) of the Cemeteries and Crematoria Regulations 2025 to which the person belongs: [*tick appropriate box]
๐ registered medical practitioner who treated the person to whom the body parts belonged
๐ registered medical practitioner of the hospital where the person to whom the body parts belonged was treated
๐ coroner
๐ inspector of a school of anatomy
๐ head of school of anatomy
๐ the Secretary
๐ authorised representative of a tissue bank
๐ the Victorian Institute of Forensic Medicine
๐ the person who was pregnant with the foetus
Signature of person supplying prescribed information (if not the applicant):
Date:
Place of cremation
Name of crematorium:
Applicant's details
Name of applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Contact person for the applicant (if relevant):
Details of funeral director or person arranging for the cremation
Is the applicant arranging for the cremation of the body parts? [*tick appropriate box]
๐ Yes ๐ No
If yes, proceed to Cremated remains.
If no, provide details below of the funeral director or person arranging the cremation of the body parts on behalf of the applicant.
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Cremated remains
Following cremation, the cremated remains are to be: [*tick appropriate box]
๐ Interred at: [specify cemetery]
Note: The cemetery trust must authorise the interment of cremated human remains: see section 141 of the Cemeteries and Crematoria Act 2003.
๐ Other: [please specify]
Type of place of interment: [specify type, e.g. grave, vault, mausoleum crypt, wall niche, memorial plant, garden bed, lawn or plot]
Location of place of interment: [specify the location, e.g. section, row, grave number or other geographical locator]
Date of cremation:
Statement by funeral director or person arranging the cremation
This section is to be completed by the funeral director or the person who is arranging for the cremation of the body parts.
Please select one option:
๐ The body parts contain no pacemaker or batteryโpowered device.
๐ I have arranged for the pacemaker or other batteryโpowered device to be removed from the body parts.
๐ The pacemaker or other batteryโpowered device has not been removed from the body parts as this is not required by the cemetery trust.
Signature of funeral director/person arranging cremation: Date:
Signature of applicant: Date:
Sch. 1 Form 11 amended by S.R. No. 114/2025 reg. 20.
Form 11
Regulation 33
Cemeteries and Crematoria Act 2003
Cemeteries and Crematoria Regulations 2025
Application TO SECRETARY for Exhumation Licence
The deceased person
Full name:
Sex: [*tick appropriate box]
๐ Male ๐ Female ๐ Other ๐ Don't know/prefer not to say
Date of birth:
Date of death:
Applicant's details
Full name of applicant:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to deceased person:
Location of current interment
Name of cemetery: [for exhumations outside of a public cemetery, please provide property details including the address and the Certificate of Title folio and volume reference or Crown allotment details]
Type of place of interment: [specify type, e.g. grave, vault, mausoleum crypt]
Location of place of interment: [specify the location, e.g. section, row, grave number or other geographical locator]
Attach a statement from the cemetery trust, land owner or land manager stating:
whether there are any reasons why the exhumation cannot be accommodated at this time; and
for public cemeteries only, the name of the current holder(s) of the right of interment as recorded in the cemetery trust records; and
that the cemetery trust, land owner or land manager consents to the exhumation.
Details of the funeral director or other person engaged to assist at the exhumation
Company name (if any):
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Consent of holder(s) of right of interment
Complete this section only if the remains are to be exhumed from a place of interment in a public cemetery. If the remains are not being exhumed from a public cemetery, proceed to Consent of nearest surviving relative(s) of the deceased person.
Is the applicant the holder of the right of interment for the place of interment from which the remains will be exhumed? [*tick appropriate box]
๐ Yes, the sole holder of the right of interment [Proceed toConsent of nearest surviving relative(s) of the deceased person]
๐ Yes, one of the holders of the right of interment
๐ No
Complete this section in respect of each holder of the right of interment for the place of interment from which the remains will be exhumed (other than the applicant). Attach additional pages if necessary.
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Relationship to deceased person:
I consent to the application for an exhumation licence.
Signature(s) of holder(s) of right of interment: Date:
Have all holders of the right of interment been informed of this application? [*tick appropriate box]
๐ Yes ๐ No
If no, give reasons why all holders of the right of interment have not been informed:
If yes, do all holders of the right of interment consent to this application? [*tick appropriate box]
๐ Yes ๐ No
Consent of nearest surviving relative(s) of the deceased person
Is the applicant the nearest surviving relative of the deceased person? [*tick appropriate box]
๐ Yes ๐ No
If yes, proceed to Notification of other surviving relatives.
If no, indicate below only the first listed category in which there is a nearest surviving relative of the deceased person: [*tick appropriate box]
๐ spouse or domestic partner of the deceased person at the time of death
๐ child or stepchild aged 18 years or over
๐ parent
๐ sibling aged 18 years or over
๐ grandparent
๐ grandchild aged 18 years or over
๐ parent's sibling aged 18 years or over
๐ sibling's child aged 18 years or over
Complete this section in respect of each nearest surviving relative of the deceased person in the indicated first listed category in which there is a nearest surviving relative of the deceased person (other than the applicant). Attach additional pages if necessary.
Full name:
I consent to the exhumation of the remains of the deceased person.
Signature: Date:
Notification of other surviving relatives
Have all other surviving relatives of the deceased person in the following categories been informed of this application? [*tick appropriate box]
spouse or domestic partner of the deceased person at the time of death
child or stepchild aged 18 years or over
parent
sibling aged 18 years or over
๐ Yes ๐ No
If no, give reasons why all other surviving relatives of the deceased person have not been informed:
If yes, has any surviving relative(s) of the deceased person objected to this application? [*tick appropriate box]
๐ Yes ๐ No
Has the parent or guardian of any minor child (including stepchild) or minor sibling of the deceased person been informed of this application? [*tick appropriate box]
๐ Yes ๐ No
If no, give reasons why the parent or guardian of the minor child or sibling has not been informed:
If yes, has the parent or guardian of the minor child or sibling objected to this application? [*tick appropriate box]
๐ Yes ๐ No
Are you aware of any objection to this application by any other surviving relative of the deceased person in any of the following categories? [*tick appropriate box]
grandparent
grandchild aged 18 years or over
parent's sibling aged 18 years or over
sibling's child aged 18 years or over
any other surviving relative not otherwise listed in this form
Disposition of the remains after exhumation
What will happen to the remains after exhumation? [*select one option only]:
๐ Reโinterred in Victoria at: [state name of cemetery]
Note: Authorisation is required to reโinter the remains.
๐ Cremated in Victoria at: [specify crematorium]
Note: Authorisation is required to cremate the remains.
๐ Transportation interstate/other location within Australia
๐ Transportation internationally
Details of executor of the deceased person's estate
Did the deceased person leave a will? [*tick appropriate box]
๐ Yes ๐ No
If the executor is a natural person, is the executor alive? [*tick appropriate box]
๐ Yes ๐ No
If yes, the following section is to be completed by the executor of the deceased person's estate:
Full name:
Street address:
Suburb/town/city: State: Postcode:
Telephone number(s):
Email:
Does the will or any other document contain instructions as to the disposal of the remains of the deceased? [*tick appropriate box]
๐ Yes ๐ No
If yes, provide evidence and attach copies of any relevant documentation, e.g. the will. Are any documents attached to this application? [*tick appropriate box]
๐ Yes ๐ No
Signature of executor: Date:
Information accompanying application
The following document accompanies this application in accordance with section 156(3) of the Cemeteries and Crematoria Act 2003: [*tick appropriate box]
๐ certificate issued under section 46 of the Births, Deaths and Marriages Registration Act 1996;
๐ copy of order made by a coroner under section 47 of the Coroners Act 2008(coroner's order)
๐ if the deceased person died outside Victoria, a document corresponding to a notice under section 37(2) of the Births, Deaths and Marriages Registration Act 1996 from the jurisdiction where the deceased person died (notice of death by treating doctorโother jurisdiction)
๐ notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996(notice of stillโbirth)
๐ if the stillโbirth occurred outside Victoria, a document corresponding to a notice of stillโbirth under the Births, Deaths and Marriages Registration Act 1996 from the jurisdiction where the stillโbirth occurred (notice of stillโbirthโother jurisdiction)
๐ statutory declaration made by the person arranging the interment stating that, owing to special circumstances, it is not possible to produce one of the documents referred to above.
WARNING
Under section 158A of the Cemeteries and Crematoria Act 2003 it is an offence to knowingly make a false statement in an application for an exhumation licence, punishable by a fine of up to 240 penalty units or 2 years imprisonment or both.