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Download DA Form 1103 also known as Application For Army Emergency Relief. This form is designed to maintain moral for soldiers and their families by providing this tool for Commander’s and First Sergeant’s to assist soldiers in the event of a financial emergency. All cases must be considered according to their own merits.

How To Fill-In

Step 1 – Application For Army Emergency Relief – Begin by filling in blocks 1 through 14 as follows:

  • 1. Section Number
  • 2. Date (yyyy/mm/dd format)
  • 3. Soldier’s Name (Last, First, MI format)
  • 4. Social Sec
  • 5. Grade
  • 6. Status
  • a. Choose Status and place an X in the box
  • b. EST Date (if active)
  • 7. Active Soldier’s Unit Address/Address Of Retiree/Survivor/Others
  • 8. Phone Number (including area code)
  • 9. Home Of Record (street, city, state, zip code)
  • 10. a. Applicant’s Name If Other Than Soldier’s
  • b. Relationship
  • c. Power Of Attorney (yes or no – check the box)
  • 11. Bankruptsy Filed Or Pending ( yes or no – if yes – chapter)
  • 12. Dependents For Which You Furnish More Than One-Half Support (complete sections 11. a., b. and c.) as follows:
  • a. Name
  • b. Age
  • c. Relationship
  • 13. Reason Why Assistance Is Needed (be specific and complete. If more space is needed continue on a separate sheet)
  • 14. List Your Specific Emergency Financial Needs (include dollar amounts and total)

Step 2 – Indebtedness – Complete by answering section 15 a. through d.:

  • a. To Whom (do you owe debt)
  • b. Date incurred
  • c. Original Amount
  • d. Monthly Payment

Step 3 – Applicant’s Certification – Read block 16. entirely. If you agree to all of the terms:

  • a. Signature of Applicant
  • b. Date (yyyy/mm/dd format)

Step 4 – Unit Commander’s Review Of Active Duty Applicant:

  • In Section 17. a. and b., read the statements and respond by checking the appropriate boxes.
  • c. Type Or Printed Name (in the box) And Signature
  • Date (yyyy/mm/dd format

Step 5 – Remarks (by Commander):

  • In Section 18. Read and respond in writing
  • If applicant’s budget is needed, acquire an ACS budget planning sheet prior to commenting

Step 6 – Action By Approval Authority – Complete blocks in Section 19 a. through f.:

  • a. Approve/Disapprove (check the box that applies)
  • b. Loan Amount $ (place that number in the block)
  • c. Grant Amount $ ( if this is a grant, place that number in the block)
  • d. Name of Approval Authority
  • e. Grade
  • f. Position

Step 7- Acknowledgment Of Assistance- Complete the following blocks in Section 20. a. through e.:

a. I acknowledge receipt of (check one of the two boxes that apply) then place the amount and check number on the appropriate lines

Read sentences b. and c. – If, in fact, you( applicant ) agrees, then move to block d. and provide signature in the “Signature of Applicant” block.

e. Date (yyyy/mm/dd format)

These forms are fillable online or printable for manual use and/or sending.

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