South West Middlesex Crematorium Board

Application for Entry in the Book of Remembrance

EACH INSCRIPTION LINE MAY ONLY CONTAIN A MAXIMUM OF 35 CHARACTERS (INCLUDING SPACES). BLOCK LETTERS PLEASE. For all entries in the Book of Remembrance, the day and month is displayed at the top of the page. If you wish the year of death to appear, this must be included in the inscription.

When writing your entry, the first line must only be used for the name of the deceased. The second is for dates and a short epitaph, if there is space.

Please choose the number of lines you require:

Line 1: Surname and Forenames

Line 2: Inscription

Line 3:

Line 4:

Line 5:

Line 6:

Line 7

Line 8:

The Board reserves the right to vary any inscription as may be found necessary or to refuse an entry which is considered unsuitable. Verses or quotations will only be accepted if from a recognised and approved source.

The entry is to be recorded in the Book of Remembrance under the following

DATE OF DEATH (or other date if required):

Details of person making this application (BLOCK LETTERS PLEASE):):

Full name
Title
Address

Contact telephone number (in case of queries)
Email address

Signed
Date

Fees (see price list)

a) Above entry in Book of Remembrance	Select?	£0.00
b) Miniature Book of Remembrance	Select? Quantity:	£0.00
c) Memorial Card	Select? Quantity:	£0.00
d) Entry in existing Miniature Book of Remembrance	Select?	£0.00
	Total:	£0.00

CHEQUES PAYABLE TO
SOUTH WEST MIDDLESEX CREMATORIUM BOARD
HOUNSLOW ROAD, HANWORTH, FELTHAM, MIDDLESEX, TW13 5JH

Tel. 020 8894 9001 enquiries@swmcrematorium.gov.uk

Office Use only

Vol: ....................

Receipt No: ....................

Cremation No: ....................