Va 21-0781 Form 2021-2024

Va 21-0781 Form: What You Should Know

Age (Include your date of birth): 2. Date of Birth (MM/DD/YYY). 2. DATE BORN (DD/MM/YYY). 3. SERVICE FOR WHICH SERVICEABLE: [COMPANY NAME: ___________; DATE OF SERVICE: __________] 4. SERVICE CALL STATUS: CONFIRMED/PENDING/DODGING/REQUESTING FOR DATE: __________ (NOTE: In order to show I've made a request for service, I've circled the time period in this statement as the time frame in which my request was filed.) 5. SERVICE CALL PERIOD COMPLETE: __________ 6. SERVICE CABINET NEXUS NUMBER /CITIZENSHIP/STATUS:________ _ ____ ____ ____ ____ __ __ __ ___ __ __ _______________ ____ ____ ____ ____ _______ 6A. CITIZENSHIP/STATUS (If applicable) (Name of citizenship/status: ___________________) 7. SERVICE CABINET NEXUS NUMBER (If applicable) (Name of service Caroline number or ___________________) 8. DIVISION/BASE (If applicable) (City/area): (List the base, division and headquarters if applicable) 9. ATTACHMENT TO AVAILABLE CABINET NEXUS NUMBER (If available) (Name of attachment to Caroline number) 10. CURRENT BASE OR DIVISION ATTACHMENTS: ________________ _____ _____________ ____ ____ __ ___ __ __ ________ __ ___ _____ _____ ____ ____ ____ _______ 11. CONTACT OF HIGHER CIRCUIT/INMATE/HARDENING: [Name of higher court/higher base/higher division] _____ _____ ____ ____ ____ __ __ __ __ ________ _____ \ \ 12. BIRTHDAY (IF AVAILABLE): ________________ 13. STATUS (Are you still a service member?: [Yes/No]) 16. TYPE OF SERVICE (If your service is not in the categories of: [A. Active Duty, [B. Retired, [C. National Guard/Reserve, [D. Military Working Dog] [E. Merchant Marine]) [If your service is a combination of the following: [A.

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