Expires 02 28 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section 1 - Emergency Contact Information. Fill in your full name, DoD Identification Number or SSN, and reporting unit code/duty station.
  3. Indicate your service/civilian category by selecting the appropriate option. Then, provide your marital status and spouse's details if applicable.
  4. List the names and relationships of your children, parents, and any other emergency contacts. Ensure all addresses and phone numbers are accurate.
  5. Move to Section 2 - Benefits Related Information. Designate beneficiaries for death gratuity and unpaid pay/allowances if you are military personnel.
  6. Complete the signature section at the end of the form, ensuring all entries are verified before signing.

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