PLEASE NOTE – IF YOU ARE OVER 18 YEARS OLD, YOU MUST CALL OUR ADULT HELPLINE (01707 278389) BEFORE COMPLETING THIS FORM

After you have called the helpline and been given a reference number*, you should print this form and return it to the office within two weeks. If you are unable to print the form, please let our helpline know and they will arrange for a copy to be sent out to you.

Application for Bereavement Support

*We will not accept forms without a reference number.