Form Dnd 2930 E – Fill Out and Use This PDF

PROTECTED A (When completed)

Application for the Memorial Ribbon

Commemorating Deceased Members of the Canadian Forces

Initial Issue Only

For administrative purposes (DO NOT FILL IN)

Section 1 - Applicant information (All information MUST be completed. Ensure correct spelling of names, including accents, spaces between letters, lower case letters, etc.)

Note: In cases where there is no executor of the estate or the executor has passed away, the next authorized family member is determined in the following order of preference: spouse or common-law partner; eldest surviving child; father and mother; or eldest surviving sibling. Others may apply and applications will be considered on a case-by-case basis.

		Executor of estate		Spouse / Common-law partner		Eldest surviving child		Eldest surviving sibling
		Mother		Father		Other (Specify):
Title (if applicable)			Last name			Given name(s)
Relationship to deceased
Address
City				Province	Country			Postal code
Telephone				Alternate telephone		Email

Section 2a - Military member (Deceased Canadian Forces) information (All information MUST be completed. Ensure correct spelling of names, including accents, spaces between letters, lower case letters, etc.)

Last name			Given name(s)
Date of birth (dd/mm/yyyy)			Date of death (dd/mm/yyyy)
Does this name appear in the 7th Book of Remembrance?:			The 7th Book of Remembrance can be consulted on line at:
Yes	No	Do not know	http://www.veterans.gc.ca/eng/collections/books/search

PROTECTED A (When completed)

Initial Issue Application (Memorial Ribbon)

Section 2b - Military service information (All information MUST be completed)

Service (Regimental) number

Note: Do not insert Social Insurance Number (SIN). The collection of the SIN is not authorized under the Canada Pension Plan (CPP) Act. INSERT only alpha-numeric Service number. If you are not in possession of either a Regimental number (pre-1967) or a current CF Service number (X11 111 111) LEAVE THIS FIELD BLANK. The Department of National Defence will contact you if further information is required in order to ascertain eligibility.

Rank upon retirement

Environment (Navy, Army or Air Force)

Name at time of service (if legally changed after release)

Section 3a - Memorial Ribbon selection information (Please indicate the number of ribbon(s) for which you are applying)

Quantity (maximum 5)		1x	2x	3x	4x	5x

Section 3b - Recipient information (All information MUST be completed)

The following individuals are to receive the Memorial Ribbon as determined by the executor or legal beneficiary. Note that those who have received the Memorial Cross may not receive the Memorial Ribbon.

1

Title (if applicable)	Last name		Given name(s)
Relationship to deceased						Date of birth (dd/mm/yyyy)
		Memorial Cross recipient?:		Yes	No
Province of residence			Country of residence
2
Title (if applicable)	Last name		Given name(s)
Relationship to deceased						Date of birth (dd/mm/yyyy)
		Memorial Cross recipient?:		Yes	No
Province of residence			Country of residence
3
Title (if applicable)	Last name		Given name(s)
Relationship to deceased						Date of birth (dd/mm/yyyy)
		Memorial Cross recipient?:		Yes	No
Province of residence			Country of residence
DND 2930-E (10-2013) CLF 2.0						Page 2 of 3

PROTECTED A (When completed)

4

Title (if applicable)	Last name		Given name(s)
Relationship to deceased						Date of birth (dd/mm/yyyy)
		Memorial Cross recipient?:		Yes	No
Province of residence			Country of residence
5
Title (if applicable)	Last name		Given name(s)
Relationship to deceased						Date of birth (dd/mm/yyyy)
		Memorial Cross recipient?:		Yes	No
Province of residence			Country of residence

Section 4a - Delivery information (All information MUST be completed. Ensure correct spelling of names, including accents, spaces between letters, lower case letters, etc.)

Note: If the application is eligible for recognition, it is possible to have the ribbon(s) sent to a sponsor for presentation. Check the appropriate box and fill in the information.

I want the ribbon(s) sent by mail directly to the address provided in Section 1.

OR

I have contacted a sponsor (as listed below) and this person or organization has agreed to present the ribbon(s).

Section 4b - Sponsor contact information - To be completed if presentation sponsored

Sponsor organization (name)

Title (if applicable)	Sponsor last name			Sponsor first name
Address (ship to)
City		Province	Country		Postal code
Telephone		Alternate telephone		Email (optional)

Section 5 - Declaration

This application is being submitted in good faith and I declare the information provided above to be true and correct and that to the best of my knowledge no other family member has applied.

Name of applicant (please print)		Signature (applicant)
Signed at (place)		Date (dd/mm/yyyy)

Submission

Please keep a copy for your records. Return original completed form along with copies of any supporting documentation to:

Directorate of Honours and Recognition

National Defence Headquarters

101 Colonel By Drive

Ottawa ON K1A 0K2

To protect your privacy and security DO NOT FAX OR E-MAIL any application forms or supporting documentation.

Applications are normally processed on a first come first serve basis. If you need help filling this form or clarification on eligibility, call 1-855-433-2976 (Toll free).