replacing Form B
This form can only be completed by a registered medical practitioner.
Please complete this form in full, if a part does not apply enter ‘N/A’.
Part 1 Details of the deceased
Occupation or last occupation if retired or not in work at the date of death
Where a past occupation of the deceased person may suggest that the death was due to industrial
disease, you should consider whether to refer the death to a coroner.
Part 2 The report on the deceased
1. What was the date and time of death of the deceased?
2. Please give the address where the deceased died.
Please state whether it was the residence of the deceased or a hotel, hospital, or nursing
Their home Hospital Other (please specify)
Hotel Nursing home
continued over the page
Regulation 16(c)(i) of the Cremation (England and Wales) Regulations 2008