Appendix 3 to

Annex A to

BGNSI 12.10

Dated 09 Jan 20

REPORTING A DEATH OF A FAMILY MEMBER

AWC/ GWAC, UK/ DVAC/ GVAC Location:	SELECT HERE

Head of Veteran Services	Reference: BGP/RECORDS/21159125

British Gurkhas Pokhara

BFPO 4

Telephone: 061 567280

Email: BGN-RecordsOfficeGroupMailbox@mod.gov.uk	Date: 01 Jul 25

There has been a death of a family member of the following ex-serviceman/ widow/ eligible dependant:

Army No:	ENTER A/NO	Rank:	SELECT RANK

Name:	Enter full Name	Unit:	SELECT UNIT

Details of the death (this is not for a pensioner) of the family member are as follows:

Name of the Deceased:	Enter FULL name	Relationship:	Enter HERE

Date of Death:	20 Feb 23	Pension Code (if applicable):	00

Reported by:	Enter FULL name

Present Home Address of the pensioner:

Village/House No:	ENTER VILLAGE	Ward No/Street:	WARD/STREET
GP/NP/Town:	ENTER GP/NP/TOWN	Post Office/Code:	POST OFFICE
Dist/County:	ENTER DISTRICT	Province/State:	ENTER ANCHAL
Tel:	ENTER TEL NUMBER	Email:	ENTER EMAIL

4. Death certificate from the Village Council or Local Registrar or relevant County (if in the UK) is attached to this report.

5. Any other relevant information:

enter text here

AWC/ GWAC, UK/ GVAC/ DVAC Stamp

Signature of SELECT :	Date:	01 Jul 25

Rank:	SELECT RANK	Name:	Enter Officer’s name