Record of Emergency Data (DD 93) AR 600-8-1 chapter 11

Designate beneficiaries

Guide for disposition of pay and allowances

Names and address’s of emergency contacts

SSN for Positive Identification

IMPORTANCE

Official and legal document designating beneficiaries of certain benefits

Provides the name and address of the person(s) to be notified in case of emergency, sickness or death

AR 600-8-1 chapter 11 - 4

DD 93 AR 600-8-1 table 11-1

Block 1, Members full last name, first name and middle name

Block 2a, Members Social Security Number (SSN)

Smith, Timothy Greg 123-45-6789

DD 93 AR 600-8-1 table 11-1

Block 2b,Members initials in ink to verify SSN

Block 3a, Service A-Army, F-Air Force, N-Navy, M-Marine Corps

Block 3b, Unit name or UIC

TGS A WABC12

DD 93 AR 600-8-1 table 11-1

Block 4a, Spouse First name, Middle initial, Maiden name (if applicable) If Service Member include Rank

If no spouse use Single, Divorced or Widowed Once married never single even if divorced

Block 4b, Complete address of Spouse

Amber L, (Doe) 1234 N 5th St. Nowhere, Ia 12345

DD 93 AR 600-8-1 table 11-1

Block 5a, First name, Middle initial and Last name if different than Sponsor’s if none so state.

If Service Member include Rank Block 5b, Relationship to sponsor (code)

03 Son / 04 Daughter / 13 Stepson 14 Stepdaughter / 33 Adopted daughter

34 Adopted son

Jane A.

Bobby J. Donald

04

13

DD 93 AR 600-8-1 table 11-1

Block 5c, Date of Birth and Complete address Block 5d, If dependents live with current spouse

no address is required Other than current spouse include Address, Name

and Relationship of person with whom they reside

19950102

20030523

DD 93 AR 600-8-1 table 11-1

Block 6a.6b, First Name, Middle initial, Last name and Complete address of Father. If Service Member include Rank

Block 7a. 7b, First Name, Middle initial, Last name, Maiden name and Complete address of Mother. If Service Member include Rank

If Parent(s) are deceased still list in blocks 6a, 7a and add “Deceased in address Block

Other than natural parents state relationship (adopted)

Gregory P. Smith

Linda M. Smith (Thomas)

123 First Ave, Middletown, Ne 54321

123 First Ave, Middletown, Ne 54321

DD 93 AR 600-8-1 table 11-1

Block 8a, Persons not to be notified, list Name and Relationship (may be multiple people)

Block 8b, List Persons to be notified instead list all Names, address’s and relationship

DD 93 AR 600-8-1 table 11-1

Block 9a, First Name, Last name, and Relationship to receive $12,000 gratuity pay if no surviving spouse or child.

ONLY PARENTS (Person in Loco Parentis Status), BROTHER, SISTERS, HALF-BLOOD AND ADOPTED CHILDREN

If Brothers or Sisters include Date of Birth Block 9b, Complete address for each Beneficiary Block 9c, Show percentage to be paid if more than

one beneficiary is listed. Note: This is used in case of no surviving spouse or

child

Gregory P. Smith (father)

Linda M. Smith (mother)

123 First Ave, Middletown, Ne 54321

50%

50%

DD 93 AR 600-8-1 table 11-1

Block 10a, First Name, Middle initial Last name, and Relationship to receive unpaid pay and allowances if “None” so State

Block 10b, Complete address of all beneficiaries Block 10c, If more than one beneficiary show

percentage

NONE

DD 93 AR 600-8-1 table 11-1

Block 11, First name, Middle initial, Last name, Relationship and Complete address of Dependents or Blood Relative Service Member designates.

Receive allotment of pay if missing, captured or interned If more than one person use percentages for amount of allotment Percentages not left to a beneficiary are set aside for Service Member

upon return Item may be left blank

DD 93

All percentages in blocks 9c and10c must always Equal

100%Percentages in block 11 do

not have to equal 100% but cannot exceed

DD 93 AR 600-8-1 table 11-1

Block 12, Insurance information Block 12a, X proper block and fill in amount in

other if applicable Insurance Co. to be notified full name and policy

numbers (Optional, helps expedite claims)

X $100,000.

DD 93 AR 600-8-1 table 11-1

Block 13, Disposition of Remains (DR) Family member to be responsible for the remains of Service Member

First name, Middle initial, Last name, and Relationship

Service member must initial DR. If address is Rural Route give specific directions Any further information that is deemed to be noted.

DR: Gregory P. Smith (father)

DD 93 AR 600-8-1 table 11-1

Block 14. Service Member verify all information is correct and sign in ink include rank, or grade

Block 15, Signature of witness include rank, or grade

Block 16, Date service member signs form (YYYYMMDD)

DD 93

If family member is a Service member include Rank with name

Cannot use P.O. Box for any address Phone numbers with area code written in

PENCIL once per Address listed on each copy

Print three copies for: Automated Records (Perm one copy) Individual Soldiers File (ISF) Soldiers Copy

DD 93

ReferenceArmy Casualty

Operations/Assistance/ Insurance AR 600-8-1 Chapter 11

DD 93 (back page) instructions

DD 93

QUESTIONS ?