Railway Dogs Benevolent Fund Claim Form Date of Claim * MM DD YYYY Owners Details * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Retired Police Dog Details Dogs Name * Dogs Date of Birth * MM DD YYYY Dogs Gender * Male Female Dog Breed * Date of Retirement * MM DD YYYY Reason for Retirement * Age Injury Illness Failure to Licence Other If Other... Claim Details Treatment * Dental Ongoing or Long-Term Illness (Including Medication) Ongoing Long-Term Injury Supportive Therapies (Inc. Physiotherapy, Hydrotherapy, Etc) Emergency Care (Inc. Out of hours support) X-Rays Blood or Other Tests Fund Award Following Death of RPD Other If Other... Claim Details * Please outline claim details including consultations, Blood Tests & Final Treatment. Amount Requested From Fund * £ Bank Details Bank Name * Name on Account * Account Number * Sort Code * Thank you! We will be in contact once the claim has been discussed or any further information is needed.Any questions please contact info@raildogs.fundThe Railway Dogs Benevolent Fund Team
