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

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.


Max File Size: 10.00 MB
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Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

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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