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You do not need to pay anyone for this application form or to help you complete this form. For assistance with this form, contact the Claims Conference or a local Jewish social service agency. These offices will assist you at no cost. Please fill out this form in English, using dark blue or black ink. This form is also available in French, German, Hebrew and Russian. To download these alternate forms, please visit our website, [www. claimscon.org. Make sure to complete all fields. If you do not have the required information](www. claimscon.org. Make sure to complete all fields. If you do not have the required information), please mark the field“unknown”. If the question does not apply to you, please mark that field as not applicable (“N/A”). This will assist us in processing your application efficiently. If additional space is needed for any of the sections, please attach your response on a separate sheet of paper. This form must be signed in front of a certifying authority (see page 8 for more details). After you complete this form, please make sure to mail us the original and not a photocopy. Thank you.  \nSECTION 1 | Are You Applying to a Specific Compensation Program?  \nTo learn more about our different compensation programs please visit our website, [www.claimscon.org](www.claimscon.org). If the Claims Conference determines that you may be eligible for additional compensation, we will automatically register you in the appropriate fund.  \nIf you know the fund to which you would like to apply, please select it below.  \n Hardship Fund  Pension Fund (Article 2/CEEF)  Child Survivor Fund  \n I don’t know. I would like the Claims Conference to determine the appropriate compensation program.  \nClaims Conference compensation programs are limited to Jewish Nazi victims who were persecuted as Jews.  \nAre you of Jewish descent or religion?  Yes  No  \nSECTION 2 | Personal Information  \nWhat is your current name?  \n\n| Family Name | First Name | Patronymic Name |\n| --- | --- | --- |\n\nHave you ever used another name, including maiden name?  \nPlease attach any documents regarding the change such as a marriage certificate or other name change document.  \n\n| Family Name | First Name | Patronymic Name |\n| --- | --- | --- |\n\n\n| Family Name | First Name | Patronymic Name |\n| --- | --- | --- |\n\n\n| Gender  Male  Female |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| What is your official date of birth? |  |  |  | Have you used another date of birth? |  |  |  |\n| Day | Month | Year |  | Day | Month | Year |  |\n\n\n| Where were you born?\u003Cbr>City/Town | Region | Country |\n| --- | --- | --- |\n\n\n|  |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| \u003Cbr>Where do you currently live?\u003Cbr>Street Building Apt City/Town |  |  |  |  |\n\n\n| Region/State/Provence |  | Country | Postal Code |\n| --- | --- | --- | --- |\n| Telephone | Email |  |  |\n\nFOR INTERNAL USE ONLY F:   CW:   UAF.4.1.23.20  1  \nSECTION 2 CONTINUED  \nWhat is your preferred language of correspondence?  \n English  Hebrew  French  Russian  German  Hungarian  \nWe can only discuss the details of your claim with you or with someone whom you specify. Is there someone whom you would like to allow us to speak with or write to regarding your claim?  \n\n| Family Name | First Name | Relationship to Applicant |\n| --- | --- | --- |\n\nAddress  \n\n| Telephone | Email |\n| --- | --- |\n\nWhere have you lived since the end of the war? List all of the countries in which you have lived from then until today.  \n\n| Country (If Germany, please include city and state) | Year From | Year To |\n| --- | --- | --- |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n\nWhat is your current citizenship?  \n\n| Country | Date of Immigration (DD/MM/YYYY) | Date Citizenship Received (DD/MM/YYYY) |\n| --- | --- | --- |\n|  |  |  |\n\nPlease list your previous citizenship or periods when you were stateless, if applicable.  \nCountry (including perio","cbCairfZkApajS0I","https://ap.wps.com/l/cbCairfZkApajS0I","pdf",216709,"English","# SECTION 1 | Are You Applying to a Specific Compensation Program?\n## SECTION 2 | Personal Information\n## SECTION 2 CONTINUED\n## SECTION 3 | Your Experience During the War\n## PART A: PERSECUTION TIME-LINE AND INFORMATION","[{\"question\":\"Is there a fee to apply for Claims Conference compensation programs?\",\"answer\":\"No fee is required to apply for Claims Conference programs. No one needs to be paid to complete the application form.\"},{\"question\":\"How should unknown or not-applicable answers be marked?\",\"answer\":\"If a required field lacks information, mark it as “unknown.” If a question does not apply, mark the field as not applicable (“N/A”) to support efficient processing.\"},{\"question\":\"What information does the form ask for about experiences during the war?\",\"answer\":\"Section 3 has two parts: Part A collects a timeline of persecution time with dates, locations, and names; Part B requests a detailed description of the applicant’s story.\"}]","Compensation Program Application - English Application Form - Claims Conference | PDF",1789833847]