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Application form for a Plaque or Vase

iCM Form
  1. APPLICATION FOR A PLAQUE OR VASE Section G stone - 15inx 20in/ Garden of Remembrance stone (GOR) - 15inX15in/Section E Granite Desk Top 18inx18in The Applicant's signature is required below for all types of memorial works (see back of form for details) Please allow up to 6 weeks for completion
  2. * means a mandatory field
  3. Details
  4. Contact Details
  5. Note: Proof of ownership will be required *
  6. Address
  7. Your Details
  8. Name of Deceased
  9. Date of Interment
  10. Is space to be left for further inspection?
  11. Label
  12. Are the family to be present when:
  13. Label
  14. Label