RESEARCHING EVIDENCE

In order for us to begin a limited search for evidence of the applicant's Holocaust experiences for the purposes of the centenarian pension, please complete the fields below. All information will be held in strict confidence. Questions concerning the research can be addressed to us through our general contact form.

Contact person's name*

Contact person's email address*

Current first and last name of applicant*

First and last name at birth of applicant*

Place of birth of applicant*

Date of birth of applicant (MM/DD/YYYY):*

Name of father of applicant*

Name of mother of applicant* (First Name, Maiden Name)

Is the applicant currently receiving the Polish pension for Holocaust survivors?
YesNo