Personal Information Full Name* Date of Birth* (Applicants over 45 must upload child-under-18 proof below.) Local Government Area* State of Origin* Nationality* Current Address* Phone Number* Email* Marital History Name of Deceased Spouse* Place of Marriage* Date of Marriage* Date of Spouse’s Death* Cause of Spouse’s Death* Place of Death* Your Age at Time of Death* Years of Widowhood* Are you remarried?* NoYes, legallyYes, traditionally Children Do you have children?* NoYes If yes, how many? List names, genders & ages of your children: Do your children live with you? YesNo Relationships & Employment Have you been in any intimate relationship since your spouse’s death?* NoYes Are you employed?* NoYes If employed, state your place of work and address: If not employed, do you have a business? NoYes If yes, what business are you doing and your business address? Income & Support Do you have other sources of income or support (e.g., family, extended relatives)?* NoYes Are you receiving any widow’s pension, benefit, or inheritance?* NoYes If yes, specify: What are your major financial struggles at this time?* What are your greatest current challenges since your spouse’s death?* Do you have a support system that currently assists you emotionally or socially?* NoYes Required Documents Upload at least 2 of the following: Spouse’s Death Certificate Marriage Certificate Government-issued ID Card Letter of Attestation Upload at least 1 of the following: Children’s Birth Certificates Photograph of Applicant with Children Declaration & Signature I hereby declare that the information provided is accurate and authorize verification by Young Widows Voice Initiative.* I agree Recent Passport Photograph* Signature* Date* [office_fields] Office Use Only Verified By Date of Verification Conducted By Membership Approved YesNo Membership ID Number [/office_fields]
