MODMO Reference Number:

Ministry of Defence Medal Office (MODMO) - Medal Application Form

(Please complete in BLOCK CAPITAL)
Please note! Medals a"arded prior to t#e econd $orld $ar can no lon%er &e iss'ed
I "is# to apply for a
Part (! )eteran*s+ er,ice Person*s Details!
Title
Surname
Other names
Surname (if different in Service to above)
Date of Birth / /
Service Number
Service RN/RM Arm RA! Reservists
Service/ Re"iment/ #or$s on enlistment
Service/ Re"iment/ #or$s on dischar"e
Details of an other Militar or #ivil Defence
service
Ran% (on dischar"e)
Dates of Service / / to / /
Details of overseas service
If yo' are t#e ser,ice person detailed a&o,e- please %o to part .
&'/'( T#e Medal Form
Part /! Applyin% on &e#alf of a li,in% )eteran+ er,iceperson
0o' m'st #old Po"er of Attorney if yo' are applyin% for t#e person detailed in part (1
)*
#onfirm that ) hold +o,er of Attorne for
and enclose a co$* not an ori"inal* ,ith this a$$lication-
2o" please %o to part .
Part /a! Applyin% on &e#alf of a Deceased )eteran+ er,iceperson
0o' m'st &e t#e official 2e3t of Kin (2oK) in order to apply
The Official No. is the first $erson from the follo,in" list ,ho is still alive- +lease tic% the relevant
bo/ (This order is based on )ntestac 0a,)
Survivin"
S$ouse
1ldest
child
+arent
1ldest
"randchild
2rand$arents
Brother
of the
,hole
Blood
Sister
of the
,hole
Blood
Brother
of the
half
Blood
Sister
of the half
Blood
Ne$he,
of the
,hole
Blood
Niece of
the
,hole
Blood
Ne$he,
of the half
Blood
Niece of
the half
Blood
Other
The Service$erson/ 3eteran4s date of death ,as / /
+lease enclose a co$ of the $erson4s death certificate or their notification of death
(this is not re5uired if the died in service)
)*
confirm that ) am the official No. for
2o" please %o to part .
Part .! Consent for email correspondence
I 'nderstand that corres$ondence transmitted b email ma be o$en to abuse because it is
transmitted over an unsecured net,or%- ) acce$t that the Ministr of Defence (MoD) ,ill not be liable
for an loss* interce$tion or unauthorised use of information transmitted this ,a- ) "ive authorit for
the MoD to corres$ond ,ith me via the email address ) have $rovided on this form-
I a't#orise the MoD Medal Office to use email ,henever $ossible in its corres$ondence ,ith me via
m nominated email address sho,n on the front of this claim form- ) acce$t that the information ma
include m $ersonal details and an other information that could com$romise m identit-
Are yo' #appy for 's to correspond ,ia email "it# yo'4 (+lease
tic% bo/ and remember to detail our address in +art ()
6es No
Data Protection
The MoD is a Data #ontroller for the Data +rotection Act '778- 9nder the act ou have a ri"ht of
access to our $ersonal information held b the 3eterans 9.- )f ou ,ant to as% for a co$ of that
information* $lease ,rite to us 5uotin" our National )nsurance number-
The MoD is committed to ensurin" that all our $ersonal data is $rocessed in accordance ,ith the
Data +rotection Act '778-
The $ersonal data (includin" sensitive $ersonal data* for e/am$le information about our $hsical or
mental health or condition) collected and contained ,ithin this form ,ill be retained on our $hsical
file and ma be used for all la,ful $ur$oses includin":
b the MoD and its a"ents in connection ,ith all matters relatin" to the A!#S claim or a
:ar +ension claim and an other claims a"ainst the MoD
b other 2overnment De$artments ,hich have a le"itimate interest in this information for
e/am$le for the $ur$oses of research or for the $revention and detection of crime-
Part 5! Declaration
2o" complete yo'r f'll details- si%n- t#en print off t#is form and finally post it to t#e address
s#o"n &elo"
I confirm t#at t#e information I #a,e %i,en is acc'rate and complete to t#e &est of my
6no"led%e and &elief1
Si"nature +rint name
Date
/ /
Address Tele$hone number
1mail address
+ostcode
T#e Ministry Of Defence Medal Office (MODMO)-Inns"ort# 7o'se- Im8in Barrac6s- Inns"ort#-
9lo'cester- 9lo'cesters#ire- 9L. (7$
7a,e yo' remem&ered to attac# copies- not ori%inals- of t#e Deat# Certificate- t#e Po"er of
Attorney- or any ot#er rele,ant information "#ic# co'ld &e 'sed to process yo'r application