MORTUARY REGISTRATION FORM

Mortuaries operating within the Canterbury-Bankstown Local Government Area are to be registered with City of Canterbury Bankstown Council for inspection under Section 112 of the Public Health Regulation 2022. This registration form is to be used by mortuaries in order to register their premises or to change any registration details with Council.

If you have any questions in regards to this form, please contact Council’s Public Health Unit on 9707 9000.

Property details

Business/trading name *

Address *

Business details

Company name *

ABN *

Contact person *

Contact number *

Postal address *

Email address *

Privacy statement

In submitting this form, you consent to Council:

1. Collecting your personal information as contained in the form; and

2. Using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process yourapplication/request.

You may access any of your personal information that Council holds upon request.

Applicant declaration

I declare that to the best of my knowledge, the information provided in this registration form is accurate and correct.

Applicant Name *

Date *

Signature *

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