Covid-19 Bereaved Families for Justice Group

Step 1 of 3

Are you already a member of the Covid-19 Bereaved Families for Justice - Cymru group?*

Yes

Do you accept that by continuing, you are happy to be considered as a member of the Group?*

The Inquiry Chair has granted the Group Core Participant status and therefore, you will only be able to participate in the event that you are deemed a member of the Group. The Chair has not granted individuals Core Participant status, only the group. You do not have to sign up via Facebook unless you wish to receive peer support from that Forum.

Yes

Thank you for your time.

The Covid-19 Bereaved Families for Justice - Cymru group have been awarded Core Participant status at the UK Inquiry. You have chosen not be deemed a member of this group, therefore there is no need to complete this form. If you have any questions, please email walescovidinquiry@hevans.com

About You

Title

First Name(s)*

Last name*

Address*

First line address Second line address City/Town County Postcode

Email Address*

Contact Number*

About Your Loved One

We appreciate that this is a difficult time and apologise for having to ask the following questions. Please know they are essential to better understanding your situation and to help us open your case properly.

Relationship to your lost loved one*

Please explain how they were lost to Covid-19. Please provide as much detail as you feel comfortable with.*

Your Loved One's Title

Your Loved One's First Name(s)*

Your Loved One's Last name*

Your Loved One's Date of birth (dd/mm/yyyy)*

Your Loved One's Occupation*

Your Loved One's Address*

First line address Second line address City/Town County Postcode

Your Loved One's Date of death (dd/mm/yyyy)*

Your Loved One's Place of death*

Do you have a copy of the death certificate?*

Yes

Other

Recorded cause of death*

Please use this space to include any additional information you wish to add:

Covid-19 Bereaved Families for Justice Group Cymru

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Thank you for your time.

About You

About Your Loved One

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