Application Form

Are you buying for yourself?

YesNo

Purchaser Details

First Name

Middle Name

Last Name

Date of Birth

Landline

Mobile

Post Code

Address Line 1

Address Line 2

Address Line 3

City / Town

County

Next of Kin

Full Name

Phone Number

Please confirm that you have read and understand the following...

What is included…

Collection of the deceased by the Funeral Director
A simple basic veneered coffin
Care and preparation of the deceased prior to cremation
Advice and guidance on all aspects of the funeral arrangements including the certification and registration of the death
Transportation of the deceased to the Crematorium Crematorium fees
Return of ashes to family/chosen person*
Any fees payable to Doctors or a Coroner for the issue of death or cremation medical certificates, or Coroners certificates

Things to consider…

There is no Chapel of Rest viewing
There is no service for family and friends to pay their final respects
Cremation only (no burial)
No choice of Crematorium
No additional extras are available for a Simple Plan

*Important Note: The ashes to be returned within C.28 days.

If you are paying by monthly instalments, if you pass away before all your instalments are paid, your family or representatives acting on your behalf will be required to settle the balance of your plan before the Funeral Director can be instructed.

I confirm I have read the above and I am happy to proceed.

By ticking this box, I confirm that I am / the client is responsible for making decisions regarding financial matters and purchases of this nature.

Plan purchaser confirms they understand that they are committing to purchasing a Capital Life Funeral Plan.

I confirm that I/the client have/has confirmed our cancellation policy - where they have 21 days in which to cancel their funeral plan in order to receive a full refund.

Thankyou for completing the application form, upon submission we will review all the information provided and get back to you to confirm.

Pre-Paid Funeral Plan Application

Ramsbottom Branch

Available 24 hours a day, 7 days week, 365 days of the year.

Haslingden Branch

Available 24 hours a day, 7 days week, 365 days of the year.

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