APPLICATION FOR REGISTRATION AS FUNERAL DIRECTOR Full name of applicant: ............. Name or style under which the business is to be carried on: ........... Full postal address of every place where the business is to be carried on:............ Address of any place of business to be used as a mortuary: ......... Application is hereby made for registration of the above-named applicant as a funeral director in respect of the above-named premises for a period from the [Date of application, or 1st day of June, 19...] until the 31st day of May, 19... Date of application: .............. Signature: .............. Capacity in which application is signed [As owner of business, partner, manager of company, or as case may be]: NB-The prescribed fee must accompany the application.