Funeral Plan Proposal Form

Person Covered

The person covered by the plan is the person for whom the plan will pay out on death. The plan can be paid for either by this person or another. The person paying for the plan is the Planholder
Name of Person to be Covered by Plan
DD slash MM slash YYYY
Address of Person Covered

Planholder (if different)

The name of the person paying for the plan. This may be the person covered by the plan or someone else (husband/wife/son/daughter).
Planholder (if different to above)
Planholder Address

Next of Kin/Executor

The next of kin/executor may not be otherwise connected with the plan at all. We will normally only contact them in connection with the plan if both the other parties are both deceased.
Next of Kin, executor or personal representative’s details (if known) if different from above
Next of kin, executor or personal representative’s address
Primary person to receive correspondence
Indicate the person nominated to receive post. If no choice is selected we will send to both person covered and planholder.
Communication Preferences
Indicate how you would prefer us to communicate.

Privacy and Sign Off

Memorialise (as the data controller) will always act responsibly with your data. We will process your personal data, which may include ‘special category data’ such as religion, in accordance with the applicable data protection law and on the legal basis that is necessary to set-up, administer and carry out your funeral plan, and for business management purposes.

We will also share your data with the whole of life assurance policy provider to which your plan is linked, administrative functions within Memorialise and our arrangers in order that they can carry out the plan when the time comes. If data processing takes place outside the European Economic Area, we will make suitable arrangements for your personal information to be protected. You can withdraw your consent to us holding your data but this may mean we are unable to carry out your funeral plan. For further information on how we manage data responsibly, please refer to our Privacy Policy.

Consent(Required)
Use your mouse or finger to electronically sign. Alternatively you may sign a paper copy. Your signature indicates acceptance of the Terms and Conditions. Your plan will not be activated until the proposal is signed and payment received. You may cancel your plan and receive a full refund if you inform us that you wish to do so within 28 days of the plan's inception.
Signed by
DD slash MM slash YYYY

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©2022 Memorialise.co.uk is owned and operated by Funeral Concierge Limited, Ratherton Farm, Ratherton, Holsworthy, Devon, EX22 6NB. Registered in England and Wales with Limited Liability; Company Registration Number: 14179167. A member of the Memorialise SA group of companies.

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