Appendix 2 to

Annex P to

BGNSI 12.10

Dated 01 Jan 20

Head of Veteran Services

British Gurkhas Pokhara

BFPO 4

Telephone: 061 567280

Email: BGN-RecordsOfficeGroupMailbox@mod.gov.uk

REQUEST FOR CHANGE OF DEPENDANT’S NAME/DATE OF BIRTH*

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

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

Name:	ENTER FULL NAME	Unit:	SELECT UNIT

Name of widow/son/daughter:	ENTER FULL NAME	wish to change name

and/or Date of Birth of my dependants/ siblings on my/ husband/ father’s Kindred Roll as follows:

Old Details

First Name	Date of Birth	Remarks
FIRST NAME	type/choose	ENTER REMARKS HERE
FIRST NAME	type/choose	ENTER REMARKS HERE
FIRST NAME	type/choose	ENTER REMARKS HERE

Name/Date of Birth* Change

First Name	Date of Birth	Reason
FIRST NAME	type/choose	ENTER REMARKS HERE
FIRST NAME	type/choose	ENTER REMARKS HERE
FIRST NAME	type/choose	ENTER REMARKS HERE

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:	enter APPLICANT’S NAME

Part 2 – To be completed by SAWO/A/AWO/A/HGW/A/BWO/EO-RECORDS/EO-GVAC/DVAC/VSO

4.	This is to confirm that I have read out and briefed paragraphs 29-31 of BGNSIs 12.10. The applicant has declared and signed the statement in my presence.

AWC/ GWAC, UK/ DVAC Stamp Applicant’s
Photo
Enter name
(First Name)

Signature of SELECT:	Date:	type/choose DATE

Rank:	SELECT RANK	Name:	enter OFFICER’S NAME

Dependants’ Photographs

Photo	Photo	Photo	Photo
Enter name	Enter name	Enter name	Enter name
(First Name)	(First Name)	(First Name)	(First Name)

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

GVAC/ DVAC Stamp Records Office Stamp GWAC, UK/AWC Stamp

Signature of SELECT:	_______________________	Date:	type/choose DATE

Rank:	SELECT RANK	Name:	enter OFFICER’S NAME