SCHEDULE (A.)E+W
Notice of Burial.E+W
I , of , being the relative [or friend, or legal representative, as the case may be, describing the relation, if a relative], having the charge of or being responsible for the burial of A.B., of , who died at in the parish of on the day of , do hereby give you notice that it is intended by me that the body of the said A.B. shall be buried within the [here describe the churchyard or graveyard in which the body is to be buried] on the day of , at the hour of , without the performance in the manner prescribed by law of the service for the burial of the dead according to the rites of the Church of England, and I give this notice pursuant to the Burial Laws Amendment Act, 1880. To the Rector [or, as the case may be] of