Appendix 2 to

Annex E to

BGNSI 12.10

Dated 31 May 19

Head of Veteran Services

British Gurkhas Pokhara

BFPO 4

Telephone: 061 567280

Email: BGN-RecordsOfficeGroupMailbox@mod.gov.uk

REQUEST FOR REGISTRATION OF DISABLED CHILD(REN)

Part 1 – To be completed by the Head of the Family/ Eligible children

I/ widow of Army No:	ENTER A/NO	Rank:	SELECT RANK

Name:	ENTER FULL NAME HERE	Unit:	SELECT UNIT

Name of widow/son/daughter:	ENTER FULL NAME HERE	wish to register the

following children as DISABLE on my/ husband/ father’s Kindred Roll:

Name	Date of Birth	DISABLED From (Date)	Mother’s Name
FIRST NAME	SELECT DOB	SELECT DATE	FIRST NAME
FIRST NAME	SELECT DOB	SELECT DATE	FIRST NAME

I have enclosed 1 x passport size photo(s) each of the above named individual(s).

My current address and contact telephone number(s) are as follows:

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

I confirm that the above details are correct.

Signature:	Date:	type/choose DATE
Rank:	SELECT RANK	Name:	Click here to enter NAME

Part 2 – To be completed by AWC Doctor – Detailed Report

I have physically checked the above-named child and find:

Child’s Disability Type (physical or mental) and General Condition.

Click here to enter text

History of the Medical Condition (e.g. at what age or date was the condition first known/identified?). Did it occur prior to age of 23? If yes, is this backed up by supporting documents (e.g. medical report or if congenital by a medical report/Ward Muchulka witnessed by close relatives)?

Click here to enter text

Do you know how long is the condition is expected to last?

Click here to enter text

Is the child incapable of self-support?

Click here to enter text

Signature of Doctor:	Date:	type/choose DATE

Grade:	Enter Grade	Name:	Click here to enter NAME

Part 3 – To be completed by SAWO/A/AWO/HGW/BWO/GWA/EO-GVAC/DVAC/VSO

This is to confirm that I have read out and briefed the contents of the Annex E to the applicant and he/she and signed the application in my presence.

Applicant’s Photo

AWC/ GVAC/ DVAC/ GWAC, UK Stamp

Enter name
(Applicant’s Name)

DISABLED Child (ren)’s Photographs

DISABLED Child’s Photo	DISABLED Child’s Photo

Click here to enter name	Click here to enter name

Note: Affixed Photo(s) is/ are to be signed across by the SAWO/A/AWO/HGW/BWO/GWA/EO-GVAC/DVAC/VSO.

SAWO/A/AWO’s Investigation Report and Recommendation:

Click here to enter text

Signature of SELECT:	Date:	type/choose DATE

Rank:	SELECT RANK	Name:	Enter Officer’s name