TNAG-2271-FCO40-3270-Hong-Kong-Her-Majesty-s-Overseas-Civil-Service-(HMOCS)-corr-1991 — Page 215

Particulars of wife

Wife's full clan or other forenames

Date of your marriage

Is your wife living with you? (Yes or No)

Place of your marriage (in full).

If you have no wife please give separate details of any child under the age of 16 years, or under 19 years if he or she is receiving full-time education.

The Personal Injuries (Civilians) Scheme states that a claim to pension must be made within three months of the date of the qualifying injury. In exceptional circumstances this time limit can be waived. Please, therefore, state your reasons for not claiming earlier.

I

WAS

COMPLETELY

UN AWARE

THAT

Σ

MIGHT

BE

ENTITLED

то

ANY

KIND

Of

PENSION

AS

A

civilian

IN FERNEE

DECLARATION

(WARNING – TO GIVE FALSE INFORMATION MAY RESULT IN PROSECUTION)

I DECLARE that to the best of my knowledge and belief the information given is true and complete. I claim pension accordingly.

I hereby authorise the doctors and hospitals named to make my medical records available to the Department to be copied for confidential retention and use for war pensions purposes.

Usual signature

Lea Mathias

Tha

(4)

Date.

13

Ok

MARCt.