DVA form 3 of 3: Corroborative information

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This form is used to gather information corroborate the claim made by the veteran. Your assistance is greatly appreciated.

Email *

Name of veteran *

First name and last name

Your name *

First name and last name

Relationship to veteran *

What is the nature of your relationship to the veteran? eg. wife, psychologist, colleague, General Practitioner

Your mobile number *

We probably will NOT need to contact you. But should we need to clarify anything we will seek the veterans consent to contact you.

Consent *

The veteran has requested that you provide information on their behalf. The information you provide will only be used for the purposes of corroborating the claim and may be included in the report prepared for DVA. You may be contacted for clarification purposes.

I consent

Required

Effect of service

Could you briefly describe the changes you have observed of the veteran as a result of service? How does who they are now compare to who they were before their military service. eg he used to have a sense of humour, now he's a humourless wreck. He no longer is comfortable in his own skin, she's always on tenterhooks, he gets upset easily, he's angry now, etc.

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