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CASUALTY ASSISTANCE KIT (to be completed by veterans, retirees and spouses, and kept in your files for your survivors to use)
Created by Stephen Cobb, USA Colonel (Ret.)
Name:
Social Security Number:
Date of Birth:
Place of Birth:
Date of Retirement:
Retired grade/rank:
Enrolled in RSFFP, SPB, SSPB (check all that apply) Did you disenroll from this plan? Yes No (check one)
VA Claim #:
Eligible to draw VA disability compensation (even if not currently in receipt): Yes No (check one)
Receiving Social Security: Yes No (check one)
If yes, age at which first received:
Organ donor: Yes No (check one)
Is there a living will?
SPOUSE INFORMATION
SSN:
MARRIAGE INFORMATION
Date of Marriage:
Place of Marriage (City, State, Country):
CHILDREN INFORMATION Name Address Birth date Incapable of self-support?
INSURANCE POLICIES Policy # Company Amount (include “as of” date) Beneficiary Agent phone #
INVESTMENTS Type (IRA, CD, Mutual Fund) Company Amount (include “as of” date) Agent phone #
BANK ACCOUNTS Bank Name Phone # Type of Acct. Amount (include “as of” date) Account # (check or savings)
CREDITORS Name & Address Phone # Account # Balance Due (include “as of” date) Life insurance?
Information used for creation of this page is courtesy of Army Echoes magazine, Issue 4, 1998 October-December, page 11.
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