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Applications/Forms

Applications and Forms

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Compliance Guide

Preneed

Applications

New Preneed Funeral Establishment Check-List
New Preneed Funeral Establishment Application
Preneed Funeral Establishment License Bond
Schedule A Form – Application for Individual Preneed Sales License
Model Form to Share Individual Preneed Sales Licensees


Insurance Funded Preneed Funeral Contracts

Standard Insurance Preneed Funeral Contract and Standard Preneed Contract SGSS
Inflation-Proof Insurance Preneed Funeral Contract & SGSS


TRUST FUNDED PRENEED FUNERAL CONTRACTS

Standard Trust Preneed Funeral Contract and Standard Preneed Contract SGSS
Inflation-Proof Trust Preneed Funeral Contract & SGSS


CERTIFICATE OF PERFORMANCE

Certificate of Performance ("COP") (9/2019)
COP – Inflation-Proof Calculator (9/2019)
COP – IP Calculator Instructions


CONSUMER REQUEST FOR BOARD TO PROVIDE COPY OF PRENEED CONTRACT

Request for Copy or Copies of Preneed Contract Documents


MISCELLANEOUS FORMS AND SAMPLE LETTERS

Individual Preneed File Check-List
Use this form to ensure each preneed funeral contract file contains those items subject to examination by Board inspectors.
Form PN-4 Substitution of Financial Instition Form
Note: This form is to be used when a preneed funeral establishment wishes to transfer its own preneed funeral trust accounts from one financial institution to another. It is not used when a purchaser wishes to transfer his or her trust funded preneed funeral contract from one preneed funeral establishment to another.
Insurance Company Request – Policy Owner Release of Information
Insurance Company Request – Funeral Home Requests Year End Policy Status Information
Procedures for Amending Previously Filed Preneed Funeral Contracts
Procedures for Revoking an Irrevocable Preneed Funeral Contract

Miscellaneous

NCBFS REQUEST FOR DELCLARATORY RULING

Form DR-1 – Request for Delcaratory Ruling

NCBFS PUBLIC RECORDS REQUEST

Request for Review of Public Records

OCME – AUTHORIZATION FOR RELEASE OF REMAINS

Form OCME 0082 – Authorization for Release of Remains

Individual Licenses

Applications

Application for Courtesy Card (fillable BFS-37(a))
Application for Individual License (fillable BFS-12(a))
Application for Reciprocal Licensure (fillable BFS-34)
Verification of Licensure for Reciprocal Application
Application for Removal and Transportation Permit (fillable BFS-60(a))
Application for Active Military Status (fillable)
Applicants for licensure as a funeral director, funeral service licensee, or embalmer may register for the required examinations by completing the documents listed under “Exam Registration”.

Exam Registration

North Carolina Laws and Rules Examination
National Board Examination
North Carolina Pathology Examination
North Carolina State Board Examination

Electronic Fingerprint

Electronic Fingerprint Submission Release of Information and Application

Alkaline Hydrolysis

HYDROLYSIS LICENSEE APPLICATIONS

New Hydrolysis Licensee Check-List
Application for New Hydrolysis Licensee Application
Application for Hydrolysis Manager Permit


AUTHORIZATIONS AND WAIVER OF 24 HOUR WAITING PERIOD

Model – Standard Alkaline Hydrolysis Authorization Form
Medical Examiner’s Authorization for Cremation
Note: G.S. § 130A-388 and 10A NCAC 44 .0501 prohibit any decedent from being cremated or hydrolyzed until a medical examiner has granted permission to do so. For cremation, those death’s certified by an attending physician, Form DHHS 1881 could be required. Currently, there is no Form DHHS 1881 equivilant specifically designated for the purpose of authorizing hydrolysis. Until which time such form is available, it is Board staff’s opinion that a funeral provider or hydrolysis licensee would be in compliance with G.S. § 130A-388 and 10 NCAC 44 .0501 to utilize Form DHHS 1181 for the purpose of obtaining a medical examiner’s permission to hydrolyze human remains.
Form 56E2 – Authorization for Alkaline Hydrolysis of Amputated Body Parts
Form BFS 56F2 – Confirmation of Fetal Death for Alkaline Hydrolysis
Form 55B – Waiver of Waiting Period for Alkaline Hydrolysis

RECORDS OF RECEIPT AND DELIVERY

Form 56G2 – Consolidated Receipts (56 A2, B2, & C2) (9/2019)
Form 56A2 – Receipt of Human Remains by Hydrolysis Licensee (9/2019)
Form 56B2 – Record of Alkaine Hydrolysis by Hydrolysis Licensee (9/2019)
Form 56C2 – Delivery of Hydrolyzed Remains from Hydrolysis Licensee (9/2019)
Form 56D2 – Delivery of Hydrolyzed Remains from Funeral Provider (9/2019)


MONTHLY REPORT

Model – Monthly Alkaline Hydrolysis Report

HYDROLYSIS FILE CHECK-LIST

Individual Hydrolysis File Check-List
Use this form to ensure each hydrolysis file contains those items subject to examination by Board inspectors.