RECORD OF EMERGENCY DATA

PRIVACY ACT STATEMENT

AUTHORITY: 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 of Defense civilian and contractor personnel, collectively referred to

as civilians, when applicable. For military personnel, it is used to designate beneficiaries for certain benefits in the event of the Service member's

death. It is also a guide for disposition of that member's pay and allowances if captured, missing or interned. It also shows names and addresses of

the person(s) the Service member desires to be notified in case of emergency or death. For civilian personnel, it is used to expedite the notification

process in the event of an emergency 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 information will delay notification and

the processing of benefits to designated beneficiaries if applicable.

INSTRUCTIONS TO SERVICE MEMBER

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

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

 

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

5. CHILDREN

a. NAME (Last, First, Middle Initial) b. RELATIONSHIP c. DATE OF BIRTH 

 (YYYYMMDD) d. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER 

DD FORM 93, JAN 2008 PREVIOUS EDITION IS OBSOLETE.

 This extremely important form is to be used by you to show the

names and addresses of your spouse, children, parents, and any

other person(s) you would like notified if you become a casualty. 

Not every item on this form is applicable to you. This form is used

by the Department of Defense (DoD) to expedite notification in

the case of emergencies or death. It does not have a legal impact

on other forms you may have completed with the DoD or your

employer.

 This extremely important form is to be used by you to show the names and

addresses of your spouse, children, parents, and any other person(s) you

would like notified if you become a casualty (other family members or fiance),

and, to designate beneficiaries for certain benefits if you die. IT IS YOUR

RESPONSIBILITY to keep your Record of Emergency Data up to date to show

your desires as to beneficiaries to receive certain death payments, and to

show changes in your family or other personnel listed, for example, as a result

of marriage, civil court action, death, or address change. 

INSTRUCTIONS TO CIVILIANS

ARMY NAVY MARINE CORPS AIR FORCE DoD CIVILIAN CONTRACTOR

SINGLE DIVORCED WIDOWED

 

 Adobe 7.0 Professional

IMPORTANT: This form is divided into two sections: Section 1 - Emergency Contact Information and Section 2 - Benefits Related

Information. READ THE INSTRUCTIONS ON PAGES 3 AND 4 BEFORE COMPLETING THIS FORM.

SECTION 1 - EMERGENCY CONTACT INFORMATION

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

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

8a. DO NOT NOTIFY DUE TO ILL HEALTH b. NOTIFY INSTEAD

10. CONTRACTING AGENCY AND TELEPHONE NUMBER (Contractors only) 

9a. DESIGNATED PERSON(S) (Military only) b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER 
11a. BENEFICIARY(IES) FOR DEATH GRATUITY

 (Military only) 

c. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER d. PERCENTAGE

12a. BENEFICIARY(IES) FOR UNPAID PAY/ALLOWANCES 

 (Military only) NAME AND RELATIONSHIP

b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER c. PERCENTAGE

13a. PERSON AUTHORIZED TO DIRECT DISPOSITION (PADD)

 (Military only) NAME AND RELATIONSHIP

14. CONTINUATION/REMARKS 

15. SIGNATURE OF SERVICE MEMBER/CIVILIAN (Include rank, rate,

 or grade if applicable)

16. SIGNATURE OF WITNESS (Include rank, rate, or grade 

 as appropriate)

17. DATE SIGNED

 (YYYYMMDD)

b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER 

SECTION 2 - BENEFITS RELATED INFORMATION

DD FORM 93 (BACK), JAN 2008 

 

b. RELATIONSHIP
All entries explained below are for electronic or typewriter

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.,"

"III" or similar designation for each name, if applicable. 

When an address is entered, include the appropriate ZIP

Code. If the member cannot provide a current address,

indicate "unknown" in the appropriate item. Addresses

shown as P.O. Box Numbers or RFD numbers should

indicate in Item 14, "Continuations/Remarks", a street

address or general guidance to reach the place of

residence. In addition, the notation "See Item 14" should be

included in the item pertaining to the particular next of kin or

when the space for a particular item is insufficient. If the

address for the person in the item has been shown in a

preceding item, it is unnecessary to repeat the address;

however, the name must be entered. Those items that are

considered not applicable to civilians will be left blank.

ITEM 1. Enter full last name, first name, and middle initial.

ITEM 2. Enter social security number (SSN).

ITEM 3a. Service. Military: Mark X in appropriate block.

Civilian: Mark two blocks as appropriate. Examples: an

Army civilian would mark Army and either Civilian or

Contractor; a DoD civilian, without affiliation to one of the

Military Services, would mark DoD and then either Civilian or

Contractor as appropriate.

ITEM 3b. Reporting Unit Code/Duty Station. See Service

Directives.

ITEM 4a. Spouse Name. Enter last name (if different from

Item 1), first name and middle initial on the line provided. If

single, divorced, or widowed, mark appropriate block.

ITEM 4b. Address and Telephone Number. Enter the

"actual" address and telephone number, not the mailing

address. Include civilian title or military rank and service if

applicable. If one of the blocks in 4a is marked, leave blank.

ITEM 5a-d. Children. Enter last name (only if different from

Item 1) first name and middle initial, relationship, and date of

birth of all children. If none, so state. Include illegitimate

children if acknowledged by member or paternity/maternity

has been judicially decreed. Relationship examples: son,

daughter, stepson or daughter, adopted son or daughter or

ward. Date of birth example: 19950704. For children not

living with the member's current spouse, include address

and name and relationship of person with whom residing in

item 5d.

ITEM 6a. Father Name. Last name, first name and middle

initial.

ITEM 6b. Address and Telephone Number of Father. If

unknown or deceased, so state. Include civilian title or

military rank and service if applicable. If other than natural

father is listed, indicate relationship.

DD FORM 93 (INSTRUCTIONS), JAN 2008

 

INSTRUCTIONS FOR PREPARING DD FORM 93

(See appropriate Service Directives for supplemental instructions for completion of this form at other than MEPS)

ITEM 7a. Mother Name. Last name, first name and middle

initial.

ITEM 7b. Address and Telephone Number of Mother. If

unknown or deceased, so state. Include civilian title or

military rank and service if applicable. If other than natural

mother is listed, indicate relationship.

ITEM 8. Persons Not to be Notified Due to Ill Health.

a. List relationship, e.g., "Mother," of person(s) listed in

Items 4, 5, 6, or 7 who are not to be notified of a casualty

due to ill health. If more than one child, specify, e.g.,

"daughter Susan." Otherwise, enter "None".

b. List relationship, e.g., "Father" or name and address of

person(s) to be notified in lieu of person(s) listed in item 8a. 

If "None" is entered in Item 8a, leave 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

next of kin or immediate family, to whom information on the

whereabouts and status of the member shall be provided if

the member is placed in a missing status. Reference 10

USC, Section 655. NOT APPLICABLE to civilians.

ITEM 9b. Address and telephone number of Designated

Person(s). NOT APPLICABLE to civilians.

ITEM 10. Contracting Agency and Telephone Number

(Contractors only). NOT APPLICABLE to military

personnel. Civilian contractors will provide the name of

their contracting agency and its telephone number. 

Example: XYZ Electric, (703) 555-5689. The telephone

number should be to the company or corporation's

personnel or human resources office.

ITEM 11a. Beneficiary(ies) for Death Gratuity (Military

only). Enter first name(s), middle initial, and last name(s) 

of the person(s) to receive death gratuity pay. A member

may designate one or more persons to receive all or a

portion of the death gratuity pay. The designation of a

person to receive a portion of the amount shall indicate the

percentage of the amount, to be specified only in 10 percent

increments, that the person may receive. If the member

does not wish to designate a beneficiary for the payment of

death gratuity, enter "None," or if the full amount is not

designated, the payment or balance will be paid as follows: 

(1) To the surviving spouse of the person, if any;

(2) To any surviving children of the person and the

descendants of any deceased children by representation;

(3) To the surviving parents or the survivor of them;

(4) To the duly appointed executor or administrator of the

estate of the person;

(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.

The member should make specific designations, as it

expedites payment.
ITEM 11a. (Continued) Seek legal advice if naming a minor

child as a beneficiary. If a member has a spouse but

designates a person other than the spouse to receive all or a

portion of the death gratuity pay, the Service concerned is

required to provide notice of the designation to the spouse. 

NOT APPLICABLE to civilians.

Item 11b. Relationship. NOT APPLICABLE to civilians.

ITEM 11c. Enter beneficiary(ies) full mailing address and

telephone number to include the ZIP Code. NOT

APPLICABLE to civilians.

ITEM 11d. Show the percentage to be paid to each person.

Enter 10%, 20%, 30%, up to 100% as appropriate. The sum 

shares must equal 100 percent. If no percent is indicated and 

more than one person is named, the money is paid in equal

shares to the persons named. NOT APPLICABLE to

civilians.

ITEM 12a. Beneficiary(ies) for Unpaid Pay/Allowance

(Military only). Enter first name(s), middle initial, last

name(s) and relationship of person to receive unpaid pay

and allowances at the time of death. The member may

indicate anyone to receive this payment. If the member

designated two or more beneficiaries, state the percentage

to be paid each in item 10c. If the member does not wish to

designate a beneficiary, enter "By Law." The member is

urged to designate a beneficiary for unpaid pay and

allowances as payment will be made to the person in order

of precedence by law (10 USC 2771) in the absence of a

designation. Seek legal advice if naming a minor child as

beneficiary. NOT APPLICABLE to civilians.

ITEM 12b. Enter beneficiary(ies) full mailing address and

telephone number to include the ZIP Code. NOT

APPLICABLE to civilians.

ITEM 12c. If the member designated two or more

beneficiaries, state the percentage to be paid each in this

section. The sum shares must equal 100 percent. NOT

APPLICABLE to civilians.

ITEM 13a. Enter the name and relationship of the Person

Authorized to Direct Disposition (PADD) of your remains

should you become a casualty. Only the following persons

may be named as a PADD: surviving spouse, blood relative

of legal age, or adoptive relatives of the decedent. If neither

of these three can be found, a person standing in loco

parentis may be named. NOT APPLICABLE to civilians.

INSTRUCTIONS FOR PREPARING DD FORM 93

(Continued)

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

 

ITEM 13b. Address and telephone number of PADD. NOT

APPLICABLE to civilians.

ITEM 14. Continuations/Remarks. Use this item for remarks

or continuation of other items, if necessary. Prefix entry with

the number of the item being continued; for example, 5/John

J./son/ 19851220/321 Pecan Drive, Schertz TX 78151. Also

use this item to list name, address, and relationship of other

persons the member desires to be notified. Other

dependents may also be listed. This block offers the

greatest amount of flexibility for the member to record other

important information not otherwise requested but

considered extremely useful in the casualty notification and

assistance process. Besides continuing information from

other blocks on this form, the member may desire to include

additional information such as: NOK language barriers,

location or existence of a Will, additional private insurance

information, other family member contact numbers, etc. If

additional space is required, attach a supplemental sheet of

standard bond paper with the information.

ITEM 15. Signature of Service Member/Civilian. Check and

verify all entries and sign all copies in ink as follows: First

name, middle initial, last name. Include rank, rate, or grade

if applicable. May be electronically signed (see DoD

Instruction 1300.18 for guidelines).

ITEM 16. Signature of Witness. Have a witness

(disinterested person) sign all copies in ink as follows: First

name, middle initial, last name. Include rank, rate, or grade

as appropriate. A witness signature is not required for

electronic versions of the DD Form 93 (see DoD Instruction

1300.18).

ITEM 17. Date the member or civilian signs the form. This

item is an ink entry and must be completed on all copies.