DD Form 1081: Statement of Agent Officer's Account

In Box 1, enter the disbursing officer's name, address and disbursing station symbol no.

In Box 2, enter the agent officer's name, grade, DoD ID and unit address; include the ZIP Code/APO number and telephone number.

Box 3, TRANSACTIONS AFFECTING AGENT OFFICER'S ACCOUNT, has b INCREASE (Received by Agent), c BEGINNING BALANCE (In Agent's Account), d DECREASE (Turned in by Agent) and e ENDING BALANCE (In Agent's Account).

Under TRANSACTIONS a, the lines are 1. BALANCE FORWARD, 2. U.S. DOLLARS, 3. FOREIGN CURRENCY, 4. MILITARY PAYMENT CERTIFICATES, 5. COLLECTIONS and 6. DEPOSITS.

Line 7. NEGOTIABLE INSTRUMENTS has A. TREASURY CHECKS, B. MILITARY PAYMENT ORDERS and C. OTHER (Specify).

Other lines are 8. PAID VOUCHERS, 9. INCORRECT VOUCHERS RETURNED and 12. TOTAL FUNDS IN HANDS OF AGENT OFFICER.

In Box 4, under DISBURSING OFFICER, a. ON ADVANCE: I have entrusted funds and/or other items as indicated in this statement to the named agent officer.

The disbursing officer enters the date in b. DATE and signs in c. SIGNATURE OF DISBURSING OFFICER.

Under AGENT OFFICER, d. ON ADVANCE: I, as agent officer, have funds and/or other items as indicated on the form. I have assumed pecuniary responsibility therefor.

In d, the agent officer will notify the disbursing officer immediately upon discovery of any loss or shortage, and has received and understands written instructions concerning duties and responsibilities as an agent officer.

The agent officer enters the date in e. DATE and signs in f. SIGNATURE OF AGENT OFFICER.

Under DISBURSING OFFICER, g. ON RETURN: I have received funds and/or other items as indicated on this statement from the named agent officer.

The disbursing officer enters the date in h. DATE and signs in i. SIGNATURE OF DISBURSING OFFICER.

Under AGENT OFFICER, j. ON RETURN: The statement of account on the form is correct.

The agent officer enters the date in k. DATE and signs in l. SIGNATURE OF AGENT OFFICER.