"*" indicates required fields We are collecting your personal information in accordance with the Information Privacy Act 2009 for the purpose of processing this application/request. The information will be only accessed by authorised employees. Your information will not be given to any other person or agency unless you have given us permission, or we are required by law.Applicant detailsPerson/business completing this application.Name* First Last Business or OrganisationPhone*Email* Enter Email Confirm Email Applicant's Address* Street Address Address Line 2 Town State Post code Legal representative of the deceasedSame as applicant* Yes No Name* First Last Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Memorial detailsName* First Last Date of death* Cemetery* Atherton New Lawn Atherton Rockley Road Herberton Malanda Millaa Millaa Mount Garnet Ravenshoe Yungaburra Memorial type* Columbarium wall Full grave slab Lawn — headstone on beam Lawn — plaque on beam Mausoleum (free standing) Vault above ground Vault below ground Memorial type* Full grave slab with headstone on plinth Full grave slab with plaque on pillow Mausoleum Vault above ground Vault below ground Memorial type* Columbarium wall Full grave slab with headstone on plinth Full grave slab with plaque on pillow Lawn — plaque on beam Memorial type* Plaque on pillow Headstone on plinth Memorial type* Columbarium wall Full grave slab Lawn — headstone on beam Lawn — plaque on beam Vault above ground Vault below ground Memorial type* Columbarium wall Full grave slab with headstone on plinth Full grave slab with plaque on pillow Lawn — plaque on beam Lawn — headstone on beam Row/Section* Plot number* Application to* Erect Renovate Remove ErectPlaque installation* Installation by TRC (bronze memorial plaques only). A fee will apply as per our fees and charges Installation by applicant (installation must adhere to TRC Local Laws. Memorials that do not adhere will be removed and costs recovered from the applicant). Upload memorial proof*Proof must show description of memorial including size (LxWxH as per cemetery specifications).Max. file size: 100 MB.Description of memorial*Describe how and where the memorial will be mounted. Attach photo of proposed structure where applicable.RenovateDescription of planned work*RemoveDescription of planned work** I agree that the information I have provided is true and correct.
