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Online Form - Funeral Director’s Licence Application

Cemeteries Act 1986

Use this form to apply for a new, or to renew an existing annual Funeral Directors Licence

Please review the following, prior to submitting your application:

  1. Cemeteries Act 1986
  2. Conditions of Issue
  3. Shire of Wyndham East Kimberley Cemeteries Local Law 2003

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Note: Incomplete forms are kept for a period of 2 day(s) hour(s), after this time the system will automatically delete your response.

Applicant Details

Application Type

Business Information

Business Address
Postal Address
Address - DIRECTOR/PARTNER 1
Address - DIRECTOR/PARTNER 2
Address - MANAGER (if different from above)

Funeral Director Licence Information

Have any of the applicants been convicted of any offence, anywhere?
Have all applicants got a National Police Clearance (issued within the last 6 months)?
Have any of the applicants ever been declared bankrupt or placed in receivership?

Attachments

Please attach documentation that will assist the Shire in determining that you meet the requirements of Section 17(2) of the Cemeteries Act, 1986.


Certification by Applicant

I have read and understood the 'Conditions of Issue', 'Shire of Wyndham East Kimberley Cemeteries Local Law 2003' & 'Cemeteries Act, Division 3'
I agree to:
I understand:
I Confirm:
I Understand:

 
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