Particulars of previous claim (if any)
Have you at HM Forces,
time been awarded a pension, gratuity, allowance or compensation for injury or disablement due to service in Chant Navy, Civil Defence, Home Guard or in any other Force, or for war injury as a civilian or for any other reason? (YES or NO) ....
AND.......
If YES please state
Type of pension, gratuity,
allowance or compensation
Amount
Name of Department and address of office which authorised payment
Reference number
Particulars of present claim
EARLIER DETERIORATION
What is the nature of the injury or disease for which you are claiming? GENERAL HEALTH THAN WOULD OTHERWISE HAVE BEEN THE CASE FOR A PERSON OF MY AGE HAD ST NOT BEEN FOR INTERNMENT If a disease when did you first begin to suffer from it? BY THE JAPANESE FROM 257/12/581 56 SEPT! If an injury, please state: Date of injury . Town and district in which it occurred.TANLEY INTERNMENT CAMP
Your address at the time of injury ......
SEE ABOVE.
DITTO
HONG KONG
AND NEGLECT
Full particulars of the circumstances in which you were injured....TARVASION
... BE FOLTING IN MENSTRUAL PROBLEMS ( GOMPLETE
FUNCTIONS 9.4.2.7.
SUSPENSION
OF NORMAL FUNCTIONS
1945-
Particulars of Civil Defence Duties
If you were injured while performing Civil Defence duties or if you are claiming for a disease which you consider is due to Civil Defence duties please state:
Name and address of Civil Defence Organisation..
Date of enrolment for Civil Defence duties
Date of discharge
Reason for discharge
Nature of duties at time of injury to which you ascribe disablement
Particulars of employment
If you were not engaged on Civil Defence duties when you were injured please give particulars of your employment. If you were in business on your own account please give the address of the business and add "self employed”.
Name and address of all employers in the twelve months before injury
HONG KONG
(I WAS
GOVERNMENT
Date of starting
Date of leaving
SEP. 1941 NOU
1946
SECONDED TO HONG KONG
HONG KONG POLICE
as PAYMASTER DURING THE BATTLE
1
Nature of employment
TAX
ASSESSOR
from 10/12/41 to 25/12/41
OF HONG KONG)
If you were unemployed at any time during the twelve months before the injury, please state the periods
(2)
A
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