APPLICATION REQUEST FOR RETROSPECTIVE CONSIDERATION TO BE TREATED AS MEDICALLY UNFIT UNDER DEFENCE (PERSONNEL) REGULATIONS 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the 'Representative' section. Indicate if you are representing yourself by selecting 'Yes' or 'No'. If 'No', provide your representative's details including full name, contact number, email address, and postal address.
3. Fill in your personal details accurately. This includes your last name, first name, date of birth, and contact information such as home phone number and email address.
4. In the 'Service Details' section, specify your service branch (Navy, Army, Air Force), periods of service, service numbers, date of separation, rank on separation, and reason for separation if known.
5. Detail any medical conditions that existed during your service that could justify a medical separation. Include dates of onset or diagnosis where possible.
6. Indicate whether you have sought treatment for these conditions and provide relevant dates. Attach all supporting medical records and documents to substantiate your application.
7. Complete the Release Authority section by authorizing the release of necessary records. Ensure you initial and sign this section to allow assessment of your application.

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