Aer Form 600 - Commander'S Referral Program Application For Army Emergency Relief (Aer) Financial Assistance Page 4

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Bankruptcy Verification Form
1. Section Number
2. Rank
Purpose: AER is required to determine if an applicant is currently in Bankruptcy prior to providing
assistance in the form of a loan. An individual affirming they are in Bankruptcy is not automatically
3. SSN or AER Client ID #
disapproved for AER assistance. AER Officers will ensure that Applicants complete this form in
conjunction with AER Forms 600 and 700.
4. Soldier’s Name
(Last, First, MI)
5. ETS Date
6a. Unit
6b. Soldier’s Home or Permanent Mailing Address, Phone # and Email
7.
I certify that I am not currently in Bankruptcy.
I certify that I am currently in Bankruptcy and that my current case is filed under Chapter _____ of the U.S. Bankruptcy Code.
(If this block is marked and Trustee information is available, please provide Trustee contact information in block 8 below)
8a.
8b. Phone Number
8c. Email Address
Trustee’s Name (Last, First, MI)
9.
Applicant Remarks (if necessary):
10. Applicant's Certification
I hereby authorize the Department of the Army to supply any requested information contained in my official Army personnel and pay files
in connection with this assistance. I authorize the Department of the Army, or any agency, to supply my latest home address, and/or
official military address to AER whenever requested.
I further understand that AER is an independent private entity, not part of the U.S. Government. This application form, therefore, is not
subject to the Privacy Act (5 U.S.C. 552a). Information provided on this application in some cases, will be provided by AER to the Army
in order to determine eligibility for and administration of financial assistance. I certify that the information provided on this verification
form is complete, true and correct.
11b. Date
11a.
Signature of Applicant
12. AER Officer Remarks (if necessary):
.
13a. Name of AER Officer
13b. Signature
13c. Date
(Local Reproduction Authorized)
AER Form 60, dated 14 July 2015
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