Dd form 2056 is a document that can be used by service members to request leave from active duty. The form must be completed and submitted to the unit commander for approval. Leave may be granted for a number of reasons, including illness, family emergencies, or training requirements. Service members should carefully review the instructions on the form to ensure that all necessary information is included. Leave requests should be submitted as early as possible to allow sufficient time for processing.
| Question | Answer |
|---|---|
| Form Name | Dd Form 2056 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | dd form 2056 word document, SGLI, E-3, E-2 |
COMMERCIAL INSURANCE SOLICITATION RECORD
For use of this form, see AR
DATA REQUIRED BY THE PRIVACY ACT
AUTHORITY: Title 10 USC, Section 3012.
PRINCIPAL PURPOSE: To furnish information regarding the insurance policy sold to members in pay grades
ROUTINE USES: Information used by Insurance Officer to counsel the member to insure that he understands the terms of the insurance policy. DISCLOSURE OF REQUESTED INFORMATION IS VOLUNTARY, HOWEVER, FAILURE TO PROVIDE THE INFORMATION WILL PRECLUDE THE PROCESSING OF ALLOTMENT FOR MEMBERS IN PAY GRADES
SECTION I - (COMPLETED BY INSURANCE COMPANY REPRESENTATIVE AND GIVEN TO APPLICANT)
TO: (CO, Military Organization of Applicant)
DATE
APPLICATION FOR AN INSURANCE POLICY ON HIS/HER LIFE HAS BEEN SUBMITTED TO MY COMPANY BY THE FOLLOWING INDIVIDUAL
LAST NAME - FIRST NAME - MIDDLE INITIAL OF APPLICANT
GRADE
TYPE OF POLICY
AMOUNT OF LIFE INSURANCE
EFFECTIVE DATE OF POLICY
MONTHLY PREMIUM
PREMIUM |
DEATH |
PAID UP INSURANCE |
EXTENDED |
GUARANTEED |
TOTAL AMOUNT OF |
YEAR END |
BENEFIT |
OR ENDOWMENT |
INSURANCE |
CASH VALUE |
PREMIUMS PAID |
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1ST |
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2D |
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3D |
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4TH |
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5TH |
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10TH |
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15TH |
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20TH |
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REMARKS (Agent will fill in here any information he deems pertinent, and will include remarks concerning any exclusions or restrictive clauses which appear in the policy applied for.)
I HAVE CURRENT AUTHORIZATION TO SOLICIT INSURANCE BUSINESS ON THIS INSTALLATION AND THE ABOVE SOLICITATION WAS ACCOMPLISHED IN ACCORDANCE WITH ALL APPLICABLE REGULATIONS
NAME AND ADDRESS OF HOME OFFICE OF COMPANY
NAME AND LOCAL ADDRESS OF REPRESENTATIVE
SIGNATURE OF REPRESENTATIVE
DA FORM 2056, AUG 2010 |
PREVIOUS EDITIONS ARE OBSOLETE. |
Page 1 of 2 |
APD PE v1.00ES
SECTION II - (COMPLETED BY APPLICANT AND FORWARDED TO INSURANCE OFFICER)
I HAVE THE FOLLOWING INSURANCE IN FORCE
(List in sequence. If additional space is necessary, continue in "REMARKS" below.)
(Include SGLI)
TYPE OF POLICY |
AMOUNT |
AMOUNT OF PREMIUM |
$ PER
$ PER
$ PER
(Check appropriate boxes) |
YES |
NO |
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(Check appropriate boxes) |
YES |
NO |
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IS IT INTENDED THAT THE INSURANCE YOU ARE |
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DO YOUR PARENTS DEPEND ON YOU |
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PURCHASING WILL REPLACE AN EXISTING POLICY? |
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FOR SUPPORT? |
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ARE YOU MARRIED? |
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IS ANY OF YOUR PAY ALLOTTED FOR THE |
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SUPPORT OF YOUR DEPENDENTS? |
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DO YOU HAVE ANY MINOR CHILDREN? |
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STATEMENT OF APPLICANT
I fully understand that the Department of the Army does not favor, sponsor, or endorse any individual commercial life insurance company. I specifically understand that the filing of an allotment is merely a convenience afforded military personnel, and does not constitute an approval by the Department of the Army of either the policy purchased or the company concerned. I further understand that the purchase of a life insurance contract, which involves the use of the allotment system for payment of premiums on such contract, is definitely a personal transaction between myself and the insurance company.
I have been advised that there are certain benefits available to survivors of service personnel, such as: payment of six times my current monthly basic pay as
gratuity (subject to a minimum payment of $800.00 or a maximum payment of $3,000.00), payment of a monthly compensation by the Veterans Administration to a widow (at the rate of $215.00 per month for the widow of an
In addition, the rate payable for widow with one or more children (under age 18) is increased by $26.00 monthly for each successive child, to a child or children and/or dependent parents educational assistance (as much as $270.00 per month) to a widow and to children, and Social Security Benefits. I further understand the valuable provisions of the class B allotment system for the purchase of United States Savings Bonds.
I request that an allotment be initiated in favor of the insurance company. The information in this section is correct and is in conformance with my desires at this time.
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(Date) |
(Signature of Applicant) |
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SECTION III - |
(TO BE COMPLETED BY INSURANCE COUNSELOR) |
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FROM: |
Insurance Counselor |
DATE: |
TO: |
Personnel Officer |
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1.Applicant has been counseled in accordance with existing instructions.
2.Applicant has had provisions of existing benefits for survivors of military personnel explained to him.
3.The essential features of type of insurance applied for appear to be understood by applicant.
4.An allotment initiated to effect regular monthly payment of premium for insurance contract can be processed.
5.If the applicant has less than $20,000 SGLI, the valuable provisions of that insurance program have been explained to him.
6.If this intended purchase of insurance will replace an existing policy, the applicant has been advised that such an action may not be in his best interest, and he should obtain advice from the company which issued the existing policy.
(Signature of Insurance Counselor)
REMARKS
DA FORM 2056, AUG 2010 |
Page 2 of 2 |
APD PE v1.00ES