Cemeteries & Crematoria NSW

Interment Services Levy

Use the form below to apply for a waiver of the interment services levy in accordance with CCNSW's Hardship Policy.

CCNSW will provide the applicant with written notice of the outcome of this application once assessed.

Important information about this form

The fields marked with an asterisk * are mandatory and must be completed in order to submit the form.

Operator

Operator name

Applicant

First name

Last name

Phone number

Position

Waiver application

Which interment services range do you fall under?

25 or fewer25 +

Total number of interment services conducted across your facilities for the 2023-2024 financial year

Total number of interment services conducted across your facilities for the 2022-2023 financial year

Total number of interment services conducted across your facilities for the 2021-2022 financial year

In submitting the application,

I confirm the operator is applying for a waiver from the interment services levy under the criteria of performing 25 interment services or fewer (or an average of fewer than 25 over the past 3 years).I declare that I am authorised to complete and lodge this application on behalf of the operator.I certify that the information provided with this application is true and correct to the best of my knowledge and belief.I understand under the Crimes Act 1900 (NSW) Part 5A, that knowingly or recklessly giving false or misleading information is a serious offence which may result in prosecution.

Select all 4 notice

Which criteria are you applying under?

Operator primarily delivers services on a charitable basisFacilities are primarily operated by a volunteer workforceYou can apply under either or both criteria. If you apply under both criteria, your statutory declaration must support this.

Statutory declarations

The statutory declaration should declare that the operator is eligible for a waiver under the eligibility criteria selected above. Suggested content for each eligibility criteria is available below.

Operator primarily delivers on a charitable basis – suggested content

Identify which type of charitable service applies e.g. free/very low price/funded by donations
Include a statement that these services are comparatively low compared with other operators in this area and include an example price comparison.

Facilities are primarily operated by volunteers – suggested content

Include a statement that facilities are primarily operated by volunteers.

Resources

Service NSW publishes information on how to complete a statutory declaration, including templates.

Upload statutory declaration (File type: doc, docx, pdf, jpg) (Maximum file size: 10 MB)

I confirm I have attached a statutory declaration.*CCNSW will be unable to assess your application if you do not include a statutory declaration.

In submitting this application,

I declare that I am authorised to complete and lodge this application on behalf of the operator.I certify that the information provided with this application is true and correct to the best of my knowledge and belief.I understand under the Crimes Act 1900 (NSW) Part 5A, that knowingly or recklessly giving false or misleading information is a serious offence which may result in prosecution.

Select all 3 notice

By submitting this form, you have read and agreed to the department's privacy statement.