RECORD OF EMERGENCY DATA

PRIVACY AC T STATEM ENT

AUTHO RITY: 5 USC 552, 10 USC 655, 1475 to 1480 and 2771, 38 USC 1970, 44 USC 3101, and EO 9397 (SSN).
PRINCIPAL PURPOSES: This form is used by military personnel and Department o f Defense civilian and contractor personnel, collectively referred to
as civilians, when applicable. For m ilitary personnel, it is used to designate beneficiaries for certain benefits in the event o f the Service m em ber's
death. It is also a guide for disposition o f that m em ber's pay and allowances if captured, missing or interned. It also shows names and addresses o f
the person(s) the Service m em ber desires to be notified in case o f em ergency or death. For civilian personnel, it is used to expedite the notification
process in the event o f an em ergency and/or the death of the member. The purpose of soliciting the SSN is to provide positive identification. All items
may not be applicable.
ROUTINE USES: None.
DISCLOSURE: Voluntary; however, failure to provide accurate personal identifier information and other solicited inform ation will delay notification and
the processing of benefits to designated beneficiaries if applicable.

INSTRUCTIONS TO SERVICE M EM BER INSTRUCTIONS TO CIVILIANS

This extrem ely im portant form is to be used by you to show the names and This extrem ely im portant form is to be used by you to show the
addresses o f your spouse, children, parents, and any other person(s) you names and addresses of your spouse, children, parents, and any
would like notified if you become a casualty (other fam ily m em bers or fiance), other person(s) you would like notified if you become a casualty.
and, to designate beneficiaries for certain benefits if you die. IT IS YOUR Not every item on this form is applicable to you. This form is used
RESPO NSIBILITY to keep your Record o f Emergency Data up to date to show by the Departm ent of Defense (DoD) to expedite notification in
your desires as to beneficiaries to receive certain death payments, and to the case o f em ergencies o r death. It does not have a legal impact
show changes in your family or other personnel listed, for example, as a result on other form s you may have completed with the DoD or your
of marriage, civil court action, death, or address change. employer.

IM PORTANT: This form is divided into tw o sections: Section 1 - Em ergency Contact Inform ation and Section 2 - Benefits Related
Inform ation. READ THE INSTRUCTIONS ON PAGES 3 AND 4 BEFORE CO M PLETING THIS FORM.

SECTION 1 - EM ERG ENCY CO NTACT INFORMATION

1. NAME (Last, First, Middle Initial) 2. SSN

3a. SERVICE/CIVILIAN CATEG ORY b. REPORTING UNIT CODE/DUTY STATION

ARMY NAVY MARINE CORPS AIR FORCE DoD CIVILIAN CONTRACTOR

4a. SPOUSE NAME (If applicable) (Last, First, Middle Initial) b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER

SINGLE DIVORCED WIDOWED

5. CHILDREN c. DATE OF BIRTH

b. RELATIONSHIP d. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
a. NAME (Last, First, Middle Initial) (YYYYMMDD)

6a. FATHER NAME (Last, First, Middle Initial) b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER

7a. M O THER NAME (Last, First, Middle Initial) b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER

8a. DO NOT NO TIFY DUE TO ILL HEALTH b. NOTIFY INSTEAD

9a. DESIGNATED PERSON(S) (Military only) b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER

10. CO NTRACTING AG EN C Y AND TELEPHO NE NUM BER (Contractors only)

DD FORM 93, JAN 2008 PREVIOUS EDITION IS OBSOLETE.

Reset
A do b e 7.0 P rofessional
 SECTION 2 - BENEFITS RELATED INFORMATION

11a. BEN EFICIARY(IES) FO R DEATH GRATUITY b. RELATIONSHIP c. ADDRESS (include ZIP Code) AND TELEPHONE NUMBER d. PERCENTAGE
(Military only)

12a. BEN EFICIARY(IES) FO R UNPAID PAY/ALLOW ANCES b. ADDRESS (include ZiP Code) AND TELEPHONE NUMBER c. PERCENTAGE
(Milttary only) NAME AND RELATIONSHIP

13a. PERSON AUTH O R IZED TO DIRECT DISPOSITION (PADD) b. ADDRESS (include ZiP Code) AND TELEPHONE NUMBER
(M ilitaryonly) NAME AND RELATIONSHIP

14. C O N TINUATIO N/REM ARKS

15. SIGNATURE OF SERVICE M EM BER/CIVILIAN (include rank, rate, 16. SIGNATURE OF W ITNESS (include rank, rate, o r grade 17. DATE SIGNED
o r grade i f applicable) as appropriate) (YYYYMMDD)

DD FORM 93 (BACK), JAN 2008 Reset

 IN S T R U C T IO N S F O R P R E P A R IN G DD FO R M 93
(See appropriate Service Directives for supplemental instructions for completion of this form at other than MEPS)

A ll en tries exp la ine d be lo w are fo r e le ctro n ic or ty p e w rite r ITEM 7a. M othe r Nam e. Last nam e, first nam e and m iddle
com pletion, exce pt th o se sp e cifica lly noted. If a co m p u te r initial.
o r ty p e w rite r is not available, print in black o r b lue -bla ck ink
insuring a legible im age on all copies. Include "Jr.," "S r.," ITEM 7b. A d d re ss and T e le ph one N u m b e r o f Mother. If
"III" o r sim ila r de sig natio n fo r each nam e, if applicable. unknow n o r deceased, so state. Include civilian title or
W hen an ad dre ss is entered, include the a p pro pria te ZIP m ilitary ran k and service if applicable. If o th e r tha n natural
Code. If th e m e m b e r can no t provide a curre nt address, m othe r is listed, indicate relationship.
indicate "u n kn o w n " in th e ap pro pria te item. A dd resse s
show n as P.O. Box N u m be rs or RFD num bers should ITEM 8. P ersons N ot to be N otified Due to Ill Health.
indicate in Item 14, "C ontin ua tion s/R em arks", a street a. List relationship, e.g., "M o th er," o f pe rson (s) listed in
ad dre ss o r general g u id ance to reach the place o f Item s 4, 5, 6, o r 7 w h o are not to be notified o f a casu alty
residence. In addition, the notation "S ee Item 14" should be due to ill health. If m ore than one child, specify, e.g.,
included in the item pertaining to the pa rticu la r next o f kin or "d a u g h te r S usa n." O therw ise, e n te r "N one".
w h en the spa ce fo r a p a rticu la r item is insufficient. If the b. List relationship, e.g., "Father^' o r nam e and ad dre ss o f
ad dre ss fo r the person in th e item has been show n in a pe rson (s) to be notified in lieu o f pe rson (s) listed in item 8a.
preceding item, it is un ne cessa ry to repeat the address; If "N one " is entered in Item 8a, leave blank.
how ever, th e nam e m ust be entered. T hose item s th a t are
con sid ered not ap plicab le to civilians w ill be left blank. ITEM 9a. T his item w ill be used to record th e nam e o f the
person o r persons, if any, o th e r than th e m em b er's prim ary
ITEM 1. E nte r full last name, first nam e, and m iddle initial. next o f kin o r im m e dia te fam ily, to w h o m inform ation on the
w h e re a b o u ts and status o f the m e m b e r shall be provided if
ITEM 2. E nte r social secu rity nu m b e r (SSN). the m e m b e r is placed in a m issing status. R eference 10
USC, S ection 655. N O T A P P L IC A B L E to civ ilian s.
ITEM 3a. Service. M ilitary: M ark X in ap pro pria te block.
C iv ilia n : M ark tw o blocks as appropriate. E xam p le s: an ITEM 9b. A d d re ss and te le p h o n e nu m b e r o f D esignated
A rm y civilian w o uld m ark A rm y and eith e r C ivilian or P erson(s). N O T A P P L IC A B L E to civ ilian s.
C ontractor; a DoD civilian, w ith o u t affiliatio n to one o f the
M ilitary Services, w o uld m ark DoD and then e ith e r C ivilian or ITEM 10. C ontracting A g e n c y and T e le ph one N u m be r
C o n tra cto r as appropriate. (C o n tra c to rs o n ly). N O T A P P L IC A B L E to m ilita ry
p erson n el. C ivilian con tra ctors w ill provide the nam e o f
ITEM 3b. R eporting U nit C o d e /D u ty S tation. See S ervice th e ir con tra cting a g en cy and its te le p h o n e num ber.
D irectives. Exam ple: X Y Z Electric, (703) 555-5689. T he tele ph on e
nu m b e r should be to th e com p an y o r corp ora tion's
ITEM 4a. S pouse Nam e. E nte r last nam e (if diffe re nt from personnel o r hum an reso urce s office.
Item 1), first nam e and m iddle initial on th e line provided. If
single, divorced, o r w idow ed , m ark ap pro pria te block. ITEM 11a. B e n eficiary(ie s) fo r Death G ra tu ity (M ilitary
o n ly ). E n te r first nam e(s), m iddle initial, and last nam e(s)
ITEM 4b. A d d re ss and T e le ph one N um ber. E nte r the o f the pe rson (s) to receive death gra tu ity pay. A m em b er
"a ctu al" ad dre ss and te le p h o n e num ber, not the m ailing m ay desig nate one o r m ore persons to receive all o r a
address. Include civilian title o r m ilitary rank and service if portion o f th e death gra tu ity pay. T he de sig natio n o f a
applicable. If one o f th e blocks in 4a is m arked, leave blank. person to rece ive a portion o f the am o un t shall indicate the
pe rcen ta ge o f the am ount, to be specified only in 10 percent
ITEM 5a-d. C hildren. E nte r last nam e (on ly if diffe re nt from increm ents, th a t the person m ay receive. If th e m em b er
Item 1) first nam e and m iddle initial, relationship, and date o f does not w ish to de sig nate a be ne ficiary fo r the p a ym en t of
birth o f all children. If none, so state. Include illegitim ate death gratuity, e n te r "N one ," o r if the full am o u n t is not
children if ackn ow led ge d by m e m b e r o r p a ternity/m atern ity designated, the p a ym en t o r balance w ill be paid as follow s:
has been ju d ic ia lly decreed. R e latio nsh ip exam ples: son,
daughter, stepson o r daughter, adopted son o r d a u g h te r or (1) To the surviving spo use o f the person, if any;
w ard. Date o f birth exam ple: 19950704. F or children not (2) To any surviving children o f the person and the
living w ith the m em b er's curre nt spouse, include address d e scen da nts o f any deceased children by representation;
and nam e and relatio nship o f person w ith w h o m residing in (3) To the surviving parents o r the su rvivo r o f them ;
item 5d. (4) To the duly ap po inte d e xe cu to r o r a d m in istra to r o f the
estate o f th e person;
ITEM 6a. F athe r Nam e. Last nam e, first nam e and m iddle (5) If the re are none o f the above, to o th e r next o f kin o f the
initial. person entitled un de r the laws o f do m icile o f the person at
the tim e o f th e person's death.
ITEM 6b. A d d re ss and T e le ph one N u m b e r o f Father. If
unknow n o r deceased, so state. Include civilian title or T he m e m b e r should m ake sp e cific designations, as it
m ilitary ran k and service if applicable. If o th e r tha n natural exp ed ites paym ent.
fa th e r is listed, indicate relationship.

DD FORM 93 (INSTRUCTIONS), JAN 2008

 IN S T R U C T IO N S F O R P R E P A R IN G DD FO R M 93
(Continued)

ITEM 11a. (Continued) S e e k legal ad vice if nam ing a m in or ITEM 13b. Address and telephone number o f PADD. NO T
child as a beneficiary. If a m e m b e r has a spouse but A P P L IC A B L E to civ ilian s.
d e sig nate s a person o th e r than the spouse to receive all o r a
portion o f th e death gra tu ity pay, th e S ervice con cern ed is ITEM 14. C o ntin uatio ns/R e m arks. Use th is item fo r rem arks
required to provide notice o f the de sig natio n to the spouse. o r con tinu atio n o f o th e r item s, if necessary. P refix en try w ith
N O T A P P L IC A B L E to civ ilian s. the nu m be r o f th e item being continued; fo r exam ple, 5/John
J./so n / 19851220/321 Pecan Drive, S chertz T X 78151. A lso
Item 11b. R elationship. N O T A P P L IC A B L E to civ ilian s. use this item to list nam e, address, and relatio nship o f oth er
persons the m e m b e r desires to be notified. O th er
ITEM 11c. E nte r b e ne ficiary(ies) full m ailing address and de pe nd ents m ay also be listed. T his block offers the
te le p h o n e nu m be r to include the Z IP Code. NO T g re atest am o un t o f fle xib ility fo r the m e m b e r to record oth er
A P P L IC A B L E to civ ilian s. im p ortan t inform ation not oth erw ise requested but
con sid ered e xtre m e ly useful in the ca su a lty notification and
ITEM 11d. S h o w th e pe rcen ta ge to be paid to each person. a ssista nce process. B esides con tinu ing inform ation from
E nte r 10%, 20% , 30% , up to 100% as appropriate. The sum o th e r blocks on th is form , the m e m b e r m ay desire to include
sha res m ust equal 100 percent. If no percent is indicated and ad ditiona l inform ation such as: N O K language barriers,
m ore than one person is nam ed, th e m on ey is paid in equal location o r existe nce o f a W ill, a d ditiona l private insurance
sha res to the persons nam ed. NO T A P P L IC A B L E to inform ation, o th e r fa m ily m e m b e r co n ta ct num bers, etc. If
civ ilian s. ad ditiona l space is required, attach a sup plem en ta l sh e e t o f
standard bond pa p e r w ith the inform ation.
ITEM 12a. B e n eficiary(ie s) fo r Unpaid P ay/A llow ance
(M ilitary o n ly ). E nte r first nam e(s), m iddle initial, last ITEM 15. S ig na tu re o f S ervice M em b er/C ivilia n. C h eck and
nam e(s) and relatio nship o f person to receive unpaid pay v e rify all en tries and sign all copies in ink as follow s: F irst
and allow an ces at the tim e o f death. The m e m b e r m ay nam e, m iddle initial, last nam e. Include rank, rate, o r grade
indicate anyone to receive th is paym ent. If the m em b er if applicable. M ay be e le ctro n ica lly signed (see DoD
de sig nate d tw o o r m ore beneficiaries, state the percentage Instruction 1300.18 fo r guidelines).
to be paid each in item 10c. If the m e m b e r does not w ish to
de sig nate a beneficiary, e n te r "B y Law." T he m e m b e r is ITEM 16. S ig na tu re o f W itness. Have a w itn ess
urged to de sig nate a be ne ficiary fo r unpaid pay and (disinte re sted person) sign all cop ie s in ink as follow s: F irst
a llow an ces as pa ym en t w ill be m ade to the person in ord er nam e, m iddle initial, last nam e. Include rank, rate, o r grade
o f pre ced ence by law (10 USC 27 71 ) in th e ab sen ce o f a as appropriate. A w itn e ss sig na tu re is not required for
designation. S e e k legal ad vice if nam ing a m in o r child as e le ctro n ic version s o f the DD Form 93 (see DoD Instruction
beneficiary. N O T A P P L IC A B L E to civ ilian s. 1300.18).

ITEM 12b. E nte r b e ne ficiary(ies) full m ailing address and ITEM 17. D ate the m e m b e r o r civilian signs the form . T his
te le p h o n e nu m be r to include the Z IP Code. NO T item is an ink entry and m ust be com pleted on all copies.
A P P L IC A B L E to civ ilian s.

ITEM 12c. If the m e m b e r de sig nate d tw o o r m ore

beneficiaries, state the pe rcen ta ge to be paid each in this
section. T he sum sha res m ust equal 100 percent. NO T
A P P L IC A B L E to civ ilian s.

ITEM 13a. E nte r the nam e and relatio nship o f the Person
A uth orize d to D irect D isposition (P A D D ) o f y o u r rem ains
should you becom e a casualty. O nly the follow ing persons
m ay be nam ed as a P A D D : surviving spouse, blood relative
o f legal age, o r ad op tive relatives o f th e decedent. If n e ithe r
o f the se three can be found, a person standing in loco
parentis m ay be nam ed. N O T A P P L IC A B L E to civ ilian s.

DD FORM 93 (INSTRUCTIONS) (BACK), JAN 2008