Cremation Request

Information about the deceased

Information about the deceased(Required)

Section 1 – Cremation Process

I acknowledge that certain implanted medical devices (including a pacemaker or any similar device) may pose a risk during cremation. I declare that I have disclosed all information regarding the presence of any such device and understand that I may be held responsible for any damages resulting from a failure to disclose this information.

Please check the appropriate box:(Required)

Yes, the deceased had an implanted device.

I have requested that the funeral director remove the device.

No, the deceased did not have any implanted device.

Prior to death, did the deceased receive any radioactive treatment or implant, or was the deceased affected by a reportable disease?

(a) Avant son décès, le défunt a-t-il reçu un traitement ou un implant radioactif, ou était-il atteint d’une maladie à déclaration obligatoire ?(Required)

Yes

I acknowledge that any implants and residual metals recovered following cremation may be recycled and that any proceeds received will be donated to a charitable organization.

I understand that due to the irreversible nature of the cremation process, personal belongings and valuable items cannot be recovered./li>

I understand that the cremated remains consist primarily of bone fragments, which will be mechanically processed and placed in an appropriate container.

I acknowledge that any casket or cremation container must be combustible and comply with applicable legislation. The deceased will be cremated in the casket or container selected prior to cremation.

Section 2 – Obligations of the Authorized Representative

In my capacity as the authorized representative, I agree, to the best of my ability, to:

Verify and respect any wishes expressed by the deceased regarding anatomical donations.
Inform the estate liquidator, if applicable, as well as the next of kin (spouse, sons, daughters) of the planned cremation.
Inform any person with whom the deceased resided, if applicable.
Provide a photograph of the deceased and/or complete a formal identification.
Inform the funeral director of any specific instructions regarding the removal of jewelry or personal effects prior to arrival at the crematorium.
Authorize and facilitate the transfer of the deceased from the place of death (hospital, care facility, or other establishment) to the authorized crematorium.

Section 3 – Authorized Representative

Section 3 – Authorized Representative(Required)

Signature of the authorized representative:(Required)

Date:(Required)