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REQUEST FOR CONTACT
Identification of Deceased Veteran
Family name:	Given name(s):
VAC file No.	Date of birth	(yyyy/mm/dd)
	Date of death	(yyyy/mm/dd)

Identification of Contact Person
Contact’s name and address: 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)

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