D9182 Claim for compensation of Funeral Expenses and ...
D9182 Claim for compensation of Funeral Expenses and ...
D9182 Claim for compensation of Funeral Expenses and ...
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SECTION D continuedDEPENDANTS DETAILSDependant 231 Full nameTitle Mr Mrs Miss Ms OtherSurnameGiven name(s)32 Home addressPOSTCODE34 Postal addressPOSTCODE35 Contact details Home telephone [ ]Work telephone [ ]MobileFacsimile [ ]E-mail36 Date <strong>of</strong> birth / /37 Gender Male Female38 Relationship to deceased(e.g. partner, son, daughter).Please attach a copy <strong>of</strong> relevant in<strong>for</strong>mation to verify relationship e.g. birth certificate39 Was dependant 2 living withthe deceased immediatelybe<strong>for</strong>e the date <strong>of</strong> death?NoYes40 Was dependant 2 dependenton the deceased <strong>for</strong>economic support at thedate <strong>of</strong> death?No Yes Wholly Mainly PartlyIf between the ages <strong>of</strong> 16 <strong>and</strong> 25 years, is this dependant a student?No Yes Full time Part time<strong>D9182</strong> 11/13 P8 <strong>of</strong> 12
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