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Dd1172 Form 2020-2023
CITY OF DUTY LOCATION
(Include Area Code/DSN)
16. PRIMARY E-MAIL ADDRESS
5. ORGANIZATION
14. ZIP CODE
15. COUNTRY
19. STATE OF DUTY
LOCATION
20. COUNTRY OF
DUTY LOCATION
SECTION II - SPONSOR/EMPLOYEE DECLARATION AND REMARKS
NOTARY SIGNATURE
AND SEAL
21. REMARKS (Cite legal documentation, as applicable.)
I certify the information provided in connection with the eligibility requirements of this form is true and accurate to the best of my knowledge.
(If not signed in the presence of the...
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