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Retiree Casualty Assistance Checklist

(For later use by next of kin) As of date: ________________

Retiree Name SSAN Service Nr

Military Grade Retirement Date Branch of Service Years of Service

Address City State ZIP

Date of Birth (DOB) Place of Birth

Date of Marriage Place of Marriage

Father’s Name DOB Place of Birth

Mother’s Maiden Name DOB Place of Birth

Documents needed to claim death benefits Location of these documents

Copies of report(s) of separation from active duty (DD Form 214, etc.)

Copies of retirement orders

Copies of birth and death certificates

Beneficiary’s birth certificate(s) and marriage and/or divorce data

Social Security data (See Part III)

VA Insurance (See Part I)

Plus – You should always have the following documents on hand:

Updated Will and Letter of Instructions

Names of banks, credit unions, etc. (account numbers)

Updated list of assets and liabilities

Insurance policies, numbers, instructions, payments, etc.

Adoption or naturalization papers (if applicable)

Part I – Veterans Affairs Data (if applicable)

VA Compensation Disability Claim Nr. Remarks

VA Insurance policy File Nr.

Type Amount Location of policies

Any known paid up additional VA insurance $ As of Date

Veteran’s claim number(s) (other) Patient’s data card Nr.

Other Remarks

Part II – Retirement Pay Data (see Retiree Account Statements)

Retired gross/net pay and allotment data:

Gross Pay $ Net Pay $ Taxable Income $

Deduction $ For Deduction $ For

Deduction $ For Deduction $ For

Deduction $ For Deduction $ For