LPF_form

Preliminary Information Contact Form

Information gathered on this form is kept confidential and will be used only by Last Post Fund counsellors to contact you in order to begin the application process.

Identification of Deceased Veteran

Please fill in as much information as you have available.

Veteran's Last Name

Veteran's Given name(s)

Service Number

VAC file Number

Date of birth

Date of death

Place of death

Province of residence at time of death

Marital Status at time of death

Identification of Contact Person

Please provide us with your name and address as contact person of the deceased.

Full Name (First, Last)

Address

Phone Number

E-mail Address

Relationship to Veteran

Please add any additional comments

Thank you. One of our counsellors will be in touch soon to begin your application process.