Application For Da Civilian Identification Card (Da Form 1602) printable pdf download

Application For Da Civilian Identification Card (Da Form 1602)

APPLICATION FOR DA CIVILIAN IDENTIFICATION CARD (DA FORM 1602)

LAST NAME:

FIRST NAME:

MI:

NAF

ORGANIZATION:

CONTR

CIVIL SVC RETIREE

STATUS:

GOLD STAR FAMILY MEMBER

EXPIRATION DATE: (EXCEPT RETIREES)

ACCESS TO OTHER INSTALLATIONS REQUIRED:

YES

SSN: (LAST 5 DIGITS ONLY)

DATE OF BIRTH: (DD/MM/YY)

GENDER:

WT:

HT:

EYES:

COLOR HAIR:

MALE

FEMALE

TYPED NAME, GRADE, ORGANIZATION OF APPROVING OFFICIAL:

DUTY PHONE:

DATE SUBMITTED:

SIGNATURE

PRIVACY ACT STATEMENT

AUTHORITY: E 0. 9397,31 U.S.C.

PRINCIPAL PURPOSE: Last five digits of SSN and DOB required to confirm identity against two (2) other forms of identification.

ROUTINE USES: This information may be disclosed as generally permitted under 5 U.S.C. of the Privacy Act of 1974.

DISCLOSURE: Voluntary; however, failure to provide requested information may preclude issuance of DA Form 1602 (DA Civilian ID Card).

FOR USE BY MILITARY PERSONNEL OFFICE ONLY

ID CARD NUMBER:

DATE ISSUED- (DD/MM/YY):

ISSUED BY:

OFFICE REMARKS:

Previous edition is obsolete and may not to be used.

IMAP-HR FORM 1, 1 SEPTEMBER 2012.

Application For Da Civilian Identification Card (Da Form 1602)