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Identification of Deceased Veteran


Given name(s):
  VAC file No. Date of birth  (yyyy/mm/dd)
Place of death Date of death (yyyy/mm/dd)

  Service No.


Veterans province of residence


Marital Status

Identification of Contact Person

Contact’s name, address, comments and other infromation:

Relationship with Veteran:     

Contact’s Phone Number: xxx-xxx-xxxx

E-mail Address:


Veteran’s Province of Residence at Time of Death
(For applications outside of Canada, select: From Outside of Canada)