THE DEFENCE MEDAL
CERTIFICATION OF EARLIER MILITARY SERVICE
FORM D.M.4.

This form is for use by ex-members of the Armed Forces, including the Home Guard, who rendered qualifying civilian service after retirement or discharge from the Armed Forces.

When the form has been completed by the claimant it should be sent, as the case may be, to the Admiralty, Whitehall, to the War Office, Whitehall (officers), Army Service Record Office (other ranks) or Air Ministry (S.7 (d), Kingsway W.C.2(ex-officers) or Air Officers in charge of Records (C.I. Cam), Gloucester (ex-airmen). If the claim is in respect of previous Home Guard service, it should be sent to appropriate Territorial Association concerned (if in Northern Ireland to the Inspector General, Royal Ulster Constabulary, or the appropriate Company Commander, Ulster Special Constabulary ). When this form is returned , certified by the appropriate authority, attach it to Form D.M.2 and send both forms to the authority responsible for the last period of civilian service.

TO BE COMPLETED IN BLOCK LETTERS

C CERTIFICATE BY CLAIMANT. I certify that to the best of my knowledge the information given above is correct. I claim that I am entitled to count the above service as qualifying service towards the required period of three years for the award of the Defence Medal.

SIGNATURE (in usual form).............................. DATE...........................

D CERTIFICATE BY NEXT OF KIN. I certify that to the best of my knowledge the above-named, who died on.....................rendered the service described above.

SIGNATURE (in usual form)........................... RELATIONSHIP TO DECEASED....................................

ADDRESS....................................... DATE....................................

E CERTIFICATE BY APPROPRIATE SERVICE OR HOME GUARD AUTHORITY. I certify that, according to records, the above-named

rendered service (a) as stated above; (b) from........................ (Delete (a) or (b) as required)

SIGNATURE............................................. OFFICIAL DESCRIPTION....................................

OFFICIAL ADDRESS OF SIGNATORY.................................... DATA..............................

D M 4

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O.H.M.S.

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