Da Form 4187/da Form 31 - Agr Enlisted Active Federal Service Retirement (Page 3 of 4) in pdf

REQUEST AND AUTHORITY FOR LEAVE

1. CONTROL NUMBER

This form is subject to the Privacy Act of 1974. For use of this form, see AR 600-8-10.

The proponent agency is ODCSPER. (See instructions on reverse)

PART I

2. NAME

)

3. SSN

4. RANK

5. DATE

(Last, First, Middle Initial

DOE, MARIE J.

111-11-1111

SSG

1 JAN 02

6. LEAVE ADDRESS

7. TYPE OF LEAVE

8. ORGN, STATION, AND PHONE NO.

(Street, City, State, ZIP Code and

Phone NO.)

YOUR UNIT

ORDINARY

MERGENCY

YOUR HOME ADDRESS

UNIT ADDRESS

PERMISSIVE TDY

OTHER

YOUR CITY, ST, ZIP

UNIT STATION/CITY

YOUR HOME PHONE

UNIT PHONE

TRANS LV/PTDY______________

NUMBER OF DAYS LEAVE

10.

DATES

a. ACCRUED

b. REQUESTED

c. ADVANCED

d. EXCESS

a. FROM

b. TO

13 JUN 02

31 AUG 02

11. SIGNATURE OF REQUESTOR

12. SUPERVISOR RECOMMENDATION/SIGNATURE

13. SIGNATURE AND TITLE OF APPROVING

AUTHORITY

APPROVAL

DISAPPROVAL

YOUR SIGNATURE

SIGNATURE AND TITLE BLOCK OF

YOUR SUPERVISOR’S SIGNATURE

APPROVING AUTHORITY

14.

DEPARTURE

a. DATE

b. TIME

c. NAME/TITLE/SIGNATURE OF DEPARTURE AUTHORITY

15.

EXTENSION

a. NUMBER DAYS

b. TIME

c. NAME/TITLE/SIGNATURE OF APPROVAL AUTHORITY

16.

RETURN

a. DATE

b. TIME

c. NAME/TITLE/SIGNATURE OF RETURN AUTHORITY

17. REMARKS

PERMISSIVE TDY IS FROM 13 JUN 02 TO 2 JUL 02

Chargeable leave is from 3 JUL 02____to 31 AUG 02____

PART II – EMERGENCY LEAVE TRANSPORTATION AND TRAVEL

18. You are authorized to proceed on official travel in connection with emergency leave and upon completion of your leave and travel will return to

home station (or location) designated by military orders. You are directed to report to the Aerial Port of Embarkation (APOE) for onward movement to

the authorized internation airport designated in your travel documents. All additional travel is chargeable to leave. Do not depart the installation

without reservations or tickets for authorized space required transportation. File a no-pay travel voucher with a copy of your travel documents or

boarding pass within 5 working days after your return. Submit request for leave extension to your commander. The American Red Cross can assist

you in notifying your commander of your request for extension of leave.

19. INSTRUCTIONS FOR SCHEDULING RETURN TRANSPORTATION:

For return military travel reservations in CONUS call the MAC Passenger Reservation Center (PRC)::

Should you require other assistance call PAP:

20. DEPARTED UNIT

21. ARRIVED APOD

22. ARRIVED APOE

23. ARRIVED HOME UNIT

(return only)

PART III – DEPENDENT TRAVEL AUTHORIZATION

25.

(Space available or required cash reimbursable)

ONE WAY

ROUND TRIP

(Space required) TRANSPORTATION AUTHORIZED FOR DEPENDENTS LISTED IN BLOCK NO. 25

DEPENDENT INFORMATION

a. DEPENDENTS

b. RELATIONSHIP

c. DATE OF BIRTH

d. PASSPORT NUMBER

(Last name, First, MI)

(Children only)

_____________________________________

___________________

__________________________

_____________________________________

___________________

__________________________

_____________________________________

___________________

__________________________

_____________________________________

___________________

__________________________

_______________________

PART IV – AUTHENICATION FOR TRAVEL AUTHORIZATION

26. DESIGNATION AND LOCATION OF HEADQUARTERS

27. ACCOUNTING CITATION

28. DATE ISSUED

29. TRAVEL ORDER NUMBER

ORDER AUTHORIZING OFFICIAL

OR AUTHENICATION

(Title and signature)

DA FORM 31, SEP 93

EDITION OF 1 AUG 75 IS OBSOLETE

Da Form 4187/da Form 31 - Agr Enlisted Active Federal Service Retirement Page 3

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