Registration Form

LAND TRANSPORT AUTHORITY OF SINGAPORE
SURVEY & LANDS DIVISION
BLOCK 5 LEVEL 2
1 HAMPSHIRE ROAD
SINGAPORE 219428
Tel: 24-hour Customer Service Line@1800-call LTA(1800-2255 582)
Fax: 6396 1136
E-Mail: feedback@lta.gov.sg

EXHUMATION OF GRAVES(PART OF) AT BUKIT BROWN & SEH ONG CEMETERIES

REGISTRATION FORM

PARTICULARS OF CLAIMANT

Name			NRIC / Passport No.	Email Address	Source

Hse / Blk No.	Level No.	Unit No.	Building Name	Street Name	Country

Postal Code	Office Tel.		Home Tel.	Mobile Phone.	Fax No.

PARTICULARS OF GRAVE(S) CLAIMED

Peg No.		Name of Deceased (HanYuPinYin):
* Deceased from Multiple graves can be claimed in a single claim by searching on Grave Number or Name of Deceased (HanYuPinYin).

Peg No	Name of Deceased	HanYuPinYin	Sex	Nationality	Date of Death	Relationship with claimant	Remarks
Please search by Peg No. or Han Yu Pin Name to claim

CLAIMANT IS REQUESTED TO INDICATE HIS/HER CHOICE BY TICKING THE APPROPRIATE BOXES BELOW

1. I would like the exhumation to be carried out by:
LTA's contractor
A private contractor whom I will engage at my own cost (exhumation by private contractor must be carried out by 31 May 2013)

2. I would like to have the exhumed remains cremated and:
stored in the Choa Chu Kang Columbarium; or
stored in the Mandai Columbarium; or
stored in the Yishun Columbarium subject to availability; or
stored in a place of my choice at my own cost; or
scattered at sea on my own at my own cost; or
scattered at sea by LTA's contractor at no cost to me and at a date & time determined by LTA.

3. I do not wish to have the exhumed remains cremated and
I will arrange for exportation of the remains at my own cost.

The particulars given above are true to the best of my knowledge and I hereby agree that LTA shall not be liable for claims, damages, costs or expenses which may arise directly or indirectly from LTA relying on the above information and acting upon the above instructions concerning the exhumation and/or cremation of the remains of the deceased abovementioned.