Forms for arranging a cremation

Forms for arranging a cremation

Due to the Cremation (England and Wales) (Amendment) Regulations 2017, that came into force from 6 April 2018 allowing Crematoria to receive electronic copies of Cremation documents Chesterfield and District Crematorium has introduced a system allowing funeral directors to submit electronic versions of cremation documentation via a secure file sharing site.

We do hope that by allowing the electronic submission of forms it will save Funeral Director's travelling time and expense, especially for those of you with longer distances, whilst reducing the impact of our service on the environment. 

This is an alternative to the current system and not a replacement. 

If you have any questions or comments, please do not hesitate to contact our office on 01246 345888.


Application forms for cremation

Select the links below to download and view the relevant documents.

Preliminary application for cremation PDF (PDF 200 KB)
Application for cremation - form 1 PDF (PDF 169 KB)
Application for cremation of body parts - form 2 PDF (PDF 147 KB)
Application for cremation of a stillborn baby - form 3 PDF (PDF 107 KB)
Combined medical certificate - form 4 PDF (PDF 72 KB)
Notice of interment PDF (PDF 179 KB)
Preliminary application for cremation - Accessible Word (Word 117 KB)


Returning a form

To return a form, please email it to or send a physical copy to:

Chesterfield and District Crematorium,
Chesterfield Road,
S43 1AU

If you have any issues with completing or returning a form, please contact the bereavement services team.


Telephone: 01246 345888

Last updated on 20 April 2023