Reference No. THE ARCTIC STAR APPLICATION PLEASE

Reference No.

(MODMO use only)

THE ARCTIC STAR APPLICATION

PLEASE COMPLETE THE FOLLOWING DETAILS IN BLOCK CAPITALS

Part 1 – Particulars of the Claimant

1. Surname: 2. Forenames (not initials): 3. Title:

4. Full address of application, plus country if non UK resident:

…………………………………………………………………………………………………………………..

……………………………………………………………………………Post Code:

5. a. Telephone number: …………………… b. Email address: ………..……………..

6. Please tick one: a. Veteran b. Widow c. Next of Kin

7. Relationship to the Veteran (if NOK):

Part 2 – Particulars of the Veteran

8. Surname: 9. Forenames (not initials):

10. a. Service No./ MN Discharge book No. (if applicable) b. Rank

c. Date of Birth / / d. Date of Death (if applicable) / /

11. Service (please tick one): a. RN/RM b. Army c. RAF d. Merchant Navy

e. Civilian f. Foreign Service (please specify )

12. Please state role

13. Received Arctic Emblem. a. Yes b. No

14. Received Soviet 40

TH

Anniversary Medal. a. Yes b. No

15. Details of service in Arctic regions (e.g. Ship(s), location, formation, squadron, regiment etc.)

plus approximate dates and convoy designations (if known):

…………………………………………………………………………………………………………………..

If you have any supporting documentation, e.g. official Record of Service, aircrew log book, please

attach copies which will assist us in determining eligibility to receive the Arctic Star. Please do not

send original documents.

Part 3 – Declaration

To the best of my knowledge the information I have given is correct and as full as possible. Please

be aware that it is an offence to knowingly withhold relevant information or give false information.

Name Signed

Date

WHEN COMPLETED PLEASE RETURN TO THE MINISTRY OF DEFENCE MEDAL OFFICE AT

THE FOLLOWING ADDRESS – THE ARCTIC STAR, MoD Medal Office, Imjin Barracks,

Innsworth, Gloucester, GL3 1HW OR EMAIL SPVA-ASBCCApp[email protected]