Application for a Memorial Seat

To apply for a memorial seat, applicants need to meet the following eligibility requirements as per the Purchase and Placement of Memorial Seats and Trees.

Eligibility

Applications must be for a deceased individual.
The individual must have had a strong connection to the local community.
The individual must have been of good standing within the community.

General Conditions

The location and design of the memorial seat must be approved by the Town before installation.
All costs (installation and maintenance) are the responsibility of the applicant.
Placement will consider public benefit and availability of suitable locations.
Memorial seats have an expected lifespan of approximately 10 years.
The Town reserves the right to relocate or remove memorial seats if required.
Personal items and ashes are not permitted on or near the memorial seat.

Plaque Requirements

Plaques must be standard size (maximum 15cm x 8cm).
Materials must be bronze or stainless steel, unless otherwise approved.
Plaque wording must be appropriate for a public setting.

Renewal and Removal

Memorial seats will be removed at the end of their lifespan.
Applicants are responsible for keeping contact details up to date.
Plaques can be collected after removal.
There is an option to apply for renewal at the end of the term.

The cost of a memorial seat is set in accordance with the Town’s annual Schedule of Fees and Charges. For 2026/27, the fee is $4,325.00 (including GST).

Applicant Details

Full name of applicant:*

Address:

Street Address:*

City:*

State:*

Post Code:*

Country:*

Contact phone number:*

Contact email:*

Individual Details

Name of person being memorialised:*

Date of passing:*

Relationship to applicant:*

Any information you'd like to share about the individual, demonstrating they meet the requirement of being of good public standing in the community:*

Memorial Details

Please select the preferred option:*

Memorial Seat (with plaque)

Preferred location: (please note popular locations are limited)*

Is there a key date that the memorial is requested by? (if applicable):*

Plaque/ template wording:*

Example provided below

Memorial Plaque Example

Acceptance*

I hereby state that I have read, understood, and agree to the requirements as outlined in the Purchase and Placement of Memorial Seats and Trees Council Policy, and that all information provided in this Application Form is true and accurate.

Policy

Purchase and Placement of Memorial Seats and Trees

Privacy and Responsible Information Sharing

The personal information collected on this form will be used by the Town of Bassendean to manage and administer its services and meet legal and governance obligations. Your information may be disclosed to relevant third parties where necessary to provide these services or where required or permitted by law.

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