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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)
Place of death Date of death (yyyy/mm/dd)

  Service No.

 

Veterans province of residence



 

 

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)



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