Da 5521 Form PDF Details

Are you familiar with the Da 5521 form? If not, you should be. This form is used to apply for a state ID in Illinois. It's important to know about this form if you're a resident of Illinois, or if you plan on traveling there in the near future. In this blog post, we'll take a closer look at the Da 5521 form and discuss the steps involved in completing it. We'll also provide some tips for anyone who needs help filling out this form. So, if you're curious about the Da 5521 form or just want to learn more about it, keep reading!

QuestionAnswer
Form NameDa 5521 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesda data designation latest, da data designation search, da beneficiary search, da data designation fillable

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RECORD OF EMERGENCY DATA AND DESIGNATION OF BENEFICIARY FOR

 

UNPAID COMPENSATION OF DECEASED NAF EMPLOYEE

 

For use of this form, see AR 215-3; the proponent agency is DCS, G1.

 

 

 

 

 

DATA REQUIRED BY THE PRIVACY ACT OF 1974

 

AUTHORITY:

10 USC 3012.

 

PRINCIPAL PURPOSE:

Obtain emergency data from NAF employees, obtain legal designation of beneficiary for unpaid compensation payable

 

to the estate of a deceased employee.

 

ROUTINE USES:

Inform appropriate authorities of name and address of individual to be notified in the event of emergency or death of

 

NAF employee; inform NAF payroll office to whom and where to send unpaid compensation due.

DISCLOSURE:

Mandatory. Failure to provide this information may result in a delay of payment of unpaid compensation of the

 

deceased NAF employee and may result in payment to the estate of the decedent rather than payment to the

 

beneficiary of the decedent's choice.

 

 

 

 

 

PART A - EMERGENCY DATA

 

 

 

 

1. EMPLOYING NAFI ACTIVITY

 

 

 

 

2. EMPLOYEE'S NAME (First, Middle, Last)

3. DOB (YYYYMMDD)

 

 

 

4. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY (Name, Address, and E-Mail Address)

5. TELEPHONE NO.

 

 

(Include area code)

6. PERSON DESIGNATED TO HANDLE ESTATE IN EVENT OF DEATH (Name, Address, and E-Mail)

7.TELEPHONE NO.

(Include area code)

PART B - DESIGNATION OF BENEFICIARY

I, the employee identified above, canceling any and all previous Designations of Beneficiary heretofore made by me, do now designate the beneficiary(ies) named below to receive any UNPAID COMPENSATIONS due and payable under existing law after my death. I understand that this Designation of Beneficiary will remain in full force and effect, unless or until cancelled by me in writing, so long as I am continuously employed in the above-named department or agency.

1. BENEFICIARY(ies) (Type or Print)

2. ADDRESS OF BENEFICIARY

3. RELATIONSHIP

4. PERCENT TO BE PAID

(First, Middle Initial, Last)

(Type or Print)

 

EACH BENEFICIARY

 

 

 

 

NAME

 

 

 

SSN

 

 

 

 

 

 

 

NAME

 

 

 

SSN

 

 

 

 

 

 

 

I hereby direct unless otherwise indicated above, that if more than one beneficiary is named, the share of any deceased beneficiary who may predecease me shall be distributed equally among the surviving beneficiaries, or entirely to the survivor. I understand that this designation of beneficiary shall be void if none of the designated beneficiaries is living at the time of my death. I hereby specifically reserve the right to cancel or change any designation of beneficiary at any time and without knowledge or consent of the beneficiary.

5. SIGNATURE OF EMPLOYEE

6. DATE OF EXECUTION (YYYYMMDD)

7. WITNESS NAME AND ADDRESS (Typed)

8.TELEPHONE NO. (Include area code)

9. NAME, TITLE, AND SIGNATURE OF AUTHORIZING OFFICIAL

10. DATE OF EXECUTION (YYYYMMDD)

DA FORM 5521, OCT 2001

DA FORM 5521-R, JUN 90, IS OBSOLETE.

USAPA V2.02ES

How to Edit Da 5521 Form Online for Free

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1. The da data designation search necessitates certain details to be inserted. Make sure the subsequent blank fields are filled out:

da 5521 form conclusion process clarified (stage 1)

2. The third stage is to fill in the next few blank fields: NAME, SSN, I hereby direct unless otherwise, SIGNATURE OF EMPLOYEE, DATE OF EXECUTION YYYYMMDD, WITNESS NAME AND ADDRESS Typed, TELEPHONE NO Include area code, NAME TITLE AND SIGNATURE OF, DATE OF EXECUTION YYYYMMDD, DA FORM OCT, DA FORM R JUN IS OBSOLETE, and USAPA VES.

da 5521 form writing process detailed (part 2)

It's simple to make an error when filling in your SSN, for that reason make sure that you take a second look before you decide to finalize the form.

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