VETERANS

Veteran’s ID Info Capture Form

Personal Information

FIRST NAME

LAST NAME

SERVICE TYPE

DFNO

RANK

BIRTH DATE

ENLISTMENT DATE

DISCHARGE DATE

lAST UNIT ATTACHED TO

DISCHARGE REASON

DP NUMBER

ID NUMBER

PHONE NO.(H)

PHONE NO.(C)

PHONE NO.(W)

NEXT OF KIN NAME (NOK)

ADDRESS

FOR OFFICIAL USE ONLY

APPROVED NOT APPROVED

Reason for non-approval of ID Card:

Signature

________________

Date

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