Columbarium Registration Form

APPLICATION #: ___________________ DATE: ___________________________

Please fill out the form carefully.

I. Information of the Deceased

Last Name

Given Name

Middle Name

Date of Birth

Date of Death

Place of Death

Last Residential Address in Caloocan City

Length of Residency in Caloocan City

II. Information of Applicant / Next of Kin

Last Name

Given Name

Middle Name

Relationship to Deceased

Sex

Age

Civil Status

Residential Address

Length of Residency (Years)

Email Address

Contact Number 1

Contact Number 2

Notice: Sections III-VI will be filled up by the office. You may now print the form with I-II only filled up.

NOTE: Please bring the following Document requirements on the Service Avail.

III. Type of Service Requested (To be filled up by the office)

Service Type

Lease Years (if Vault)

Proposed Inurnment

Proposed Cremation

IV. Documentary Requirements Submitted(To be filled up by the office)

Application Form

Birth Certificate / Marriage Contract

Proof of Residency (Deceased)

Proof of Residency (Next of Kin)

Police Report / Certificate of Cremation

Urn Transfer Permit

Registered Death Certificate

V. Declaration and Undertaking(To be filled up by the office)

I hereby certify that all information stated herein is true and correct. I understand and agree to comply with all rules, regulations, and conditions governing the use of the Caloocan City Columbarium, including the non-transferability of the privilege granted.

Signature of Applicant

Printed Name

Date

VI. For Official Use Only(To be filled up by the office)

Application Status

Remarks

Processed By

Designation

Date