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THE DEFENCE MEDAL
CERTIFICATION OF EARLIER CIVILIAN SERVICE
FORM D.M.3.

This form is to be completed by claimants whose qualifying service has been with more than one authority or employer. A separate form D.M.3, is required for each period of service other than the last period. (The last period of service will be certified on Form D.M.2.) Complete sections A, B, & C. If claim is on behalf of a deceased person complete sections A,B, & D. Form D.M. 3 is not required if qualification is under paras. 2 or 3 of the instructions, Form D.M.I. The completed form should be sent to the authority shown in para. 15 of the instructions. If the application is in respect of Fire Guard duties at business premises (Category 17) the form, with certificate E completed, will be sent by the occupier or employer to the Local Authority or Government Department which was concerned with the Fire Guard arrangements at the premises, who will complete certificate F and return the form to the claimant. The Form D.M.3 with Form D.M.2 should then be sent to the authority responsible for the last period of service rendered. (see para. 15 of D.M.I). If the last period of service was with the Armed Forces, Form D.M.3 should be attached to A.F.B.2068 or to the letter of application to the Admiralty or Air Ministry or R.A.F. Records office.

If a Form D.M.3 in respect of category 17 service is not returned within two months of the date on which it was sent to the occupier, the applicant should complete a copy of the Form D.M.3 and send it with the claim on Form D.M.2(or A.F.B. 2068 or letter to Admiralty or Air Ministry) to the authority responsible for the last period of service, explaining why the D.M.3 is forwarded without certification by the occupier.

Should a Form D.M.3 in respect of category 17 service be returned undelivered by the post office, the incomplete form should be attached to the Form D.M.2(or A.F.B. 2068 or letter of application).

A PERSONAL PARTICULARS (TO BE COMPLETED IN BLOCK LETTERS)

B PARTICULARS OF QUALIFYING SERVICE

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 OCCUPIER OR EMPLOYER in respect of Fire Guard (including Civil Defence or Fire Brigade) duties at business premises (Category 17). To be signed by the occupier of the premises, or by a responsible officer on behalf of the occuppier, who should then send the form (except in the case of local government or police premises) to the Clerk to the Local Authority or Government Department which last acted as the appropriate authority for the premise; under the Fire Guard (Business and Government Premises) Order 1943.

I certify that, to the best of my knowledge, the above-named rendered service at my/our premises (a) as stated above, (b) from

.................................to........................... (Delete (a) or (b) as required).

SIGNATURE................................. STATUS OF SIGNATORY.................................

BUSINESS ADDRESS................................. DATE.......................................

F CERTIFICATE BY THE APPROPRIATE AUTHORITY in the case of persons who performed Fire Guard (including Civil Defence and Fire Brigade) duties at business premises (Category 17).

I certify that, to the best of my knowledge, the service claimed in this form (a) may be accepted as Category 17 service, (b) cannot be

accepted as Category 17 service because(Delete (a) or (b) as required)....................................

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

OFFICIAL ADDRESS OF SIGNATORY.................................... DATE...........................

G CERTIFICATE BY EMPLOYING AUTHORITY in the case of service other than Category 17 service. This certificate should be signed by a responsible officer of the authority responsible for the service claimed.

I certify that, to the best of my knowledge, the above-named rendered services (a) as stated above; (b) from..................

to........................... (Delete (a) or (b) as required).

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

OFFICIAL ADDRESS OF SIGNATORY............................................................ DATE....................................

D M 3

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O.H.M.S

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