AUTHORIZATION/DESIGNATION FOR EMERGENCY PAY AND ALLOWANCES
(Read Privacy Act Statement on back before completing form)
1. MEMBER (Last Name, First Name, Middle Initial)
3. SOCIAL SECURITY NUMBER
2. GRADE, RATE OR RANK
4. MEMBER'S STATION OR ORGANIZATION
5.a. PRIMARY DEPENDENT'S NAME (or designated representative for minor dependents) (First Name,
b. RELATIONSHIP
Middle Initial,Last Name)
6. DEPENDENTS OTHER THAN PRIMARY
b. DATE
b. DATE
a. NAME
a. NAME
OF BIRTH
OF BIRTH
(Last Name, First Name, Middle Initial)
(Last Name, First Name, Middle Initial)
(YYYYMMDD)
(YYYYMMDD)
(1)
(5)
(2)
(6)
(3)
(7)
(4)
(8)
7. PAYMENT DESIGNATION
$
a. ADVANCE OF PAY - MAXIMUM AMOUNT
(Not to exceed 2 months basic pay)
I hereby authorize an advance of basic pay, as indicated above, to be paid to my above named dependent or representative, in the event of an
emergency declared by proper authority. I understand that any amount of my basic pay paid to my dependent or representative will be deducted
from pay and allowances due me.
b. EVACUATION ALLOWANCE (Designated dependent or representative)
c. EVACUATION DISLOCATION ALLOWANCE (Designated dependent or representative)
I hereby designate the above named individual to receive the payment checked in the event of an evacuation ordered or approved by
competent authority.
d. DATE
e. SIGNATURE OF MEMBER
f. SIGNATURE OF PRIMARY DEPENDENT (or designated representative for minor dependent)
g. DATE
h. NAME, SIGNATURE, AND TITLE OF AUTHENTICATING OFFICIAL(S)
8. RECORD OF PAYMENTS
e. TYPE OF PAYMENT
a.
d.
b.
c.
(Advance of Pay -
f.
DATE
PAYROLL NO.
Dislocation Allowance -
DISBURSING OFFICER
SYMBOL NUMBER
AMOUNT PAID
(YYYYMMDD)
OR VOUCHER NO.
Evacuation Allowance)
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DD FORM 1337, NOV 2007
PREVIOUS EDITION IS OBSOLETE.
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