NAVMC 10922 at a glance
What it is: NAVMC 10922 is the Dependency Application (1751), and all previous editions are obsolete and will not be used.
Who signs: In SECTION 7 CERTIFICATION, the Marine signs under I CERTIFY that all the above statements are true to the best of my knowledge and belief, and enters the Social Security Number and Grade.
A filled-in NAVMC 10922 example: a Marine adds a child
How to fill out NAVMC 10922, box by box
Date of application and reason for this application
Enter the DATE OF APPLICATION.
Under REASON FOR THIS APPLICATION (CHECK ONE), check START or CHANGE IN DEPENDENTS. Under CHANGE IN DEPENDENTS (Check one), check one, for example GAIN.
Section 1 Marine and Organization
Enter the NAME OF MARINE (Last, first, middle), SSN, GRADE and TYPE OF SERVICE: USMC or USMCR.
Enter the organization and station preparing this application and the UNIT RUC.
Enter the DATE OF CURRENT ENLISTMENT/APPOINTMENT OR DATE REPORTING FOR ACTIVE DUTY (WHICHEVER IS LATER) and the DATE OF LAST DISCHARGE OR DATE OF LAST RELEASE TO INACTIVE DUTY.
Enter the FUTURE ADDRESS AND ETA IF TRANSFER IS ANTICIPATED WITHIN 60 DAYS.
Enter the ECC.
Section 2 Dependent Information
In SECTION 2 DEPENDENT INFORMATION, enter the NO., the NAME OF DEPENDENT (Include full given name), the COMPLETE ADDRESS (Include Zip Code), the RELATIONSHIP and the DATE OF BIRTH (Day, Mo., Year).
Enter the DATE ALLOWANCE CLAIMED FROM (If previously approved, give date of approval).
Section 3 Custodian
In SECTION 3, enter the DEP NO, the FULL NAME OF CUSTODIAN, the RELATIONSHIP TO DEPENDENT and the ADDRESS AND ZIP CODE of the custodian of any dependent.
Section 4 Present Marriage
In SECTION 4, under INFORMATION CONCERNING PRESENT MARRIAGE, check NO or YES: HAVE YOU BEEN PREVIOUSLY MARRIED? and HAS PRESENT SPOUSE BEEN PREVIOUSLY MARRIED?
Check NO or YES, and enter the NO OF TIMES.
Enter the DATE, the PLACE (County and State) and the FULL GIVEN NAME OF SPOUSE.
Dissolution of Each Former Marriage
If either answer is YES, enter the INFORMATION CONCERNING DISSOLUTION OF EACH FORMER MARRIAGE OF BOTH YOURSELF AND/OR SPOUSE (Continue on separate sheet if necessary), with the NAME OF THE SPOUSE IN THE DISSOLVED MARRIAGE.
Enter the REASON (Check one), the DATE OF DISSOLUTION and the Place of dissolution (County and State).
Check YOUR- or SPOUSE, and check DEATH, ANNULMENT or DIVORCE.
Court Order or Written Agreement
Check NO or YES: IS THERE A COURT ORDER OR WRITTEN AGREEMENT IN EFFECT RELATIVE TO SUPPORT/MAINTENANCE/PATERNITY? If yes, state date and place (county and state) where such order/agreement was issued and attach a copy.
Section 5 Natural Parent of Child in Armed Forces
In Section 5, check NO or YES: has natural parent other than claimant of child(ren) listed ever been a member of any armed forces?
Section 6 Spouse in Armed Forces
In Section 6, has your spouse ever been a member of any U.S. armed force? If yes, complete SSN, GRADE, TYPE OF SERVICE, BRANCH OF SERVICE, INCLUSIVE DATES OF ACTIVE SERVICE and BAQ.
Check REGULAR or RESERVE, and check WITH DEPENDENTS or WITHOUT DEPENDENTS.
Section 7 Certification
Immediately inform the Commanding Officer of any change in the number and/or status of dependents, whether it be the gain of additional dependents, or the loss of dependents.
The signature is Subscribed and sworn before me this day of 20, and the attesting officer signs with Signature and Title of Attesting Officer.
Sources
[1] NAVMC 10922 (Rev. 4-01), Dependency Application (1751), U.S. Marine Corps (the Official source link on this page).