Plate in BLACK MARMORITE for Columbarium and Garden of Remembrance Marmorite plate, 19 x 14 cm with photo, centered Marmorite plate, 19 x 14 cm without picture Concerned *Interest in a plaqueplate orderChoice of marmorite plaque *19 x 14 cm., with photo, centered19 x 14 cm., without pictureFirst name(s) *First name(s) to be written on the plateNouns) *NAME(s) to be written on the plateyear of birth *Year to be written on the plateYear of death *Year to be written on the platePhoto attachedDrag and Drop (or) Choose FilesAccepted format: jpg, jpeg, bmp, tif, tiff, png or psdCemetery of *Cemetery where the Columbarium, the Jardin-du-Souvenir or the tomb is located, where the plaque will be placedyour identityMrs.SirYour First Name(s) + SURNAME(s) / Visa *First name(s) + NAME(s) (or visa) of the person placing the orderRelationship with the deceasedHusband WifeSpouse/cohabitantFather motherBrother sisterSon daughterfriend/companionOther (to be specified in the additional information)E-mail *Your email or email of the municipal service concernedTelephone *Your telephone number or that of the municipal administrationAddress *Mailing address (street and number)ZIP Location *Further information)Send your orderPlease do not fill in this field.