Dd Form 93 - Record For Emergency Data Page 3

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(See appropriate Service Directives for supplemental instructions for completion of this form at other than MEPS)
All entries explained below are for electronic or typewriter
ITEM 7a. Mother Name. Last name, first name and middle
completion, except those specifically noted. If a computer
or typewriter is not available, print in black or blue-black ink
insuring a legible image on all copies. Include "Jr.," "Sr.,"
ITEM 7b. Address and Telephone Number of Mother. If
"III" or similar designation for each name, if applicable.
unknown or deceased, so state. Include civilian title or
When an address is entered, include the appropriate ZIP
military rank and service if applicable. If other than natural
Code. If the member cannot provide a current address,
mother is listed, indicate relationship.
indicate "unknown" in the appropriate item. Addresses
shown as P.O. Box Numbers or RFD numbers should
ITEM 8. Persons Not to be Notified Due to Ill Health.
indicate in Item 14, "Continuations/Remarks", a street
a. List relationship, e.g., "Mother," of person(s) listed in
address or general guidance to reach the place of
Items 4, 5, 6, or 7 who are not to be notified of a casualty
residence. In addition, the notation "See Item 14" should be
due to ill health. If more than one child, specify, e.g.,
included in the item pertaining to the particular next of kin or
"daughter Susan." Otherwise, enter "None".
when the space for a particular item is insufficient. If the
b. List relationship, e.g., "Father" or name and address of
address for the person in the item has been shown in a
person(s) to be notified in lieu of person(s) listed in item 8a.
preceding item, it is unnecessary to repeat the address;
If "None" is entered in Item 8a, leave blank.
however, the name must be entered. Those items that are
considered not applicable to civilians will be left blank.
ITEM 9a. This item will be used to record the name of the
person or persons, if any, other than the member's primary
ITEM 1. Enter full last name, first name, and middle initial.
next of kin or immediate family, to whom information on the
whereabouts and status of the member shall be provided if
ITEM 2. Enter social security number (SSN).
the member is placed in a missing status. Reference 10
USC, Section 655. NOT APPLICABLE to civilians.
ITEM 3a. Service. Military: Mark X in appropriate block.
Civilian: Mark two blocks as appropriate. Examples: an
ITEM 9b. Address and telephone number of Designated
Army civilian would mark Army and either Civilian or
Person(s). NOT APPLICABLE to civilians.
Contractor; a DoD civilian, without affiliation to one of the
Military Services, would mark DoD and then either Civilian or
ITEM 10. Contracting Agency and Telephone Number
Contractor as appropriate.
(Contractors only). NOT APPLICABLE to military
personnel. Civilian contractors will provide the name of
ITEM 3b. Reporting Unit Code/Duty Station. See Service
their contracting agency and its telephone number.
Example: XYZ Electric, (703) 555-5689. The telephone
number should be to the company or corporation's
ITEM 4a. Spouse Name. Enter last name (if different from
personnel or human resources office.
Item 1), first name and middle initial on the line provided. If
single, divorced, or widowed, mark appropriate block.
ITEM 11a. Beneficiary(ies) for Death Gratuity (Military
only). Enter first name(s), middle initial, and last name(s)
ITEM 4b. Address and Telephone Number. Enter the
of the person(s) to receive death gratuity pay. A member
"actual" address and telephone number, not the mailing
may designate one or more persons to receive all or a
address. Include civilian title or military rank and service if
portion of the death gratuity pay. The designation of a
applicable. If one of the blocks in 4a is marked, leave blank.
person to receive a portion of the amount shall indicate the
percentage of the amount, to be specified only in 10 percent
ITEM 5a-d. Children. Enter last name (only if different from
increments, that the person may receive. If the member
Item 1) first name and middle initial, relationship, and date of
does not wish to designate a beneficiary for the payment of
birth of all children. If none, so state. Include illegitimate
death gratuity, enter "None," or if the full amount is not
children if acknowledged by member or paternity/maternity
designated, the payment or balance will be paid as follows:
has been judicially decreed. Relationship examples: son,
daughter, stepson or daughter, adopted son or daughter or
(1) To the surviving spouse of the person, if any;
ward. Date of birth example: 19950704. For children not
(2) To any surviving children of the person and the
living with the member's current spouse, include address
descendants of any deceased children by representation;
and name and relationship of person with whom residing in
(3) To the surviving parents or the survivor of them;
item 5d.
(4) To the duly appointed executor or administrator of the
estate of the person;
ITEM 6a. Father Name. Last name, first name and middle
(5) If there are none of the above, to other next of kin of the
person entitled under the laws of domicile of the person at
the time of the person's death.
ITEM 6b. Address and Telephone Number of Father. If
unknown or deceased, so state. Include civilian title or
The member should make specific designations, as it
military rank and service if applicable. If other than natural
expedites payment.
father is listed, indicate relationship.


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