Fillable Dd Form 93 - Record For Emergency Data (Page 3 of 4) in pdf

INSTRUCTIONS FOR PREPARING DD FORM 93

(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

initial.

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.

Directives.

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

initial.

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.

DD FORM 93 (INSTRUCTIONS), JAN 2008

Dd Form 93 - Record For Emergency Data Page 3

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