FUNERALS
APPLICATION FORM FOR TOMBSTONE
1. DETAILS OF APPLICANT
TITTLE
MR MRS MS
INITIALS :
SURNAME :
NAME & SURNAME :
IDENTITY NUMBER :
DATE OF BIRTH:
RESIDENTIAL ADDRESS:
WORK TEL:
HOME TEL:
CELL:
EMAIL:
2. DETAILS OF DECEASED
SURNAME:
NAMES:
DATE OF BIRTH:
DATE OF DEATH:
DATE OF BURIAL:
DATE OF INSTALLATION:
PLACE OF INSTALLATION:
GRAVE NO:
3.1 CASH PAYMENT
TYPE OF STONE
MATERIAL
TOMBSTONE PRICE
R
R
POLISH
ALL
FRNT
CODE/SIZE LETTERING
R
HEAD STONE
ACCESORIES
R
KERBS
TOMBSTONE FEE
R
CHIPS
OTHER
R
LEDGER
SPECIAL REQUEST
R
FLOWER POT
R
STATUE
R
BIRBLE
R
PHOTO FRAME
R
ENGRAVED
PHOTO
TOTAL AMOUNT
R
R
MESSAGE
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3.2. INSTALMENT PURCHASE
3 MONTHS+ 10%
DEPOSIT AMOUNT
6 MONTHS
R
12 MONTHS+10%
Over 12 months Balance + 10%
MONTLY INSTALLMENT
R__________ + R__________ (lettering)+ R____________ (accessories) = TOTAL
INCEPTION DATE
PAYABLE MONTHLY R_________________
DATE OF
AMOUNT
REC NO
RECIEVED BY
PAYMENT
BALANCE DUE
1ST PAYMENT
2ND PAYMENT
3RD PAYMENT
4TH PAYMENT
5TH PAYMENT
6TH PAYMENT
7TH PAYMENT
8TH PAYMENT
9TH PAYMENT
10TH PAYMENT
11TH PAYMENT
12TH PAYMENT
FINAL PAYMENT
DATE
4. TERMS & CONDITIONS
1.1
1.2
1.3
1.4
Payment agreement must be kept according to agreement should a payment be skipped there will be a fine
Installations exceeding 100km will be charged for transportation
There will be no refund should you decide to cancel the tombstone before the end of the agreed period.
Tombstone fee is paid by applicant to the relevant cemetery and is payable before tombstone is erected
I___________________________________________________ Id No: _________________________________
understand and agree with the terms and conditions set out in this document, I have read and understood them,
everything has been explained to me clearly in the language that I understand. I undertake to abide by these
terms and condition. I therefore state that the information I provided is true and if false I will take full
responsibility for it.
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SIGNATURE
DATE
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Kgatso Funerals (Sales Agent/Branch Manager)
SPECIAL DESIGN SKECTH OR ADDITIONAL REQUIREMENTS FROM THE FAMILY
FOR OFFICE USE ONLY
AFTER INSTALLATION REPORT
PERSON CALLING: _____________________________ DATE: _____________________________________
PERSON CONTACTED: _________________________ PHONE NO USED: _____________________________
FAMILY COMMENTS:
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MEMORIAL CONDITIONS OF AGREEMENT
 This agreement will become binding as soon as this document is signed by both parties.
 Only original receipts issued by Kgatso Funerals will be accepted as proof of payment.
KGATSO FUNERALS GUARANTEES THE TOMBSTONE
 5 years from the date of delivery against cracking of the tombstone.
 The purchaser acknowledging that Granite and marble are natural products and may vary in
colour and grain structure.
 The guarantee excludes damage resulting from normal wear and decay as well as damages
caused through vandalism, natural forces and disaster.
 This guarantee will lapse in the event of the memorial being removed by any party but Kgatso
Funerals.
 Please note that the memorial is in no way to be touched before the cement has dried (1 day) in
which case the guarantee will be also lapse.
 There will be NO REFUND, if the PURCHASER decides to cancel his agreement with KGATSO
FUNERALS.
BURIAL AND UNVEILING
 KGATSO FUNERALS will, from the instructions of the customer be able to erect the tombstone on
the same day as the burial or on a grave considered to have already stabilized. And we will do
our best to erect the tombstone of high quality and standard. However it must be noted that
where the tombstone subside after sometime as a result of grave instability, KGATSO FUNERALS
will accept no responsibility on repairs, damage or replacements caused by such.
I, __________________________________________________________________ the undersigned hereby agree to have read
and understood the above declaration by KGATSO FUNERALS, and I agree that I shall purchase and not
put any form of responsibility on the damage, repairs and replacements caused by subsiding of stones
erected on the same day as burial or on a grave considered not to have already stabilized.
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NAME AND SURNAME followed by Signature
DATE
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KGATSO FUNERALS SALES PERSON followed by Signature
DATE
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WITNESS
DATE