Encl. (1) to COMDTINST 5512.10
For all other Ready Reserve members and Reserve retirees entitled to pay at age 60, but who have
not reached age 60, leave blank.
BLOCK 61 through 88. Enter in the same manner as prescribed for Blocks 33 through 60.
SECTION III - SPONSOR DECLARATION AND REMARKS
BLOCK 89. REMARKS. Enter the method of verification and further explanation of entitlement
status such as marriage certificate, birth certificate, or court order for adoption. Indicate other
appropriate comments, such as, "sponsor provides over 50 percent support", "sponsor will not sign"
or "sponsor unavailable to sign." (This block may contain up to 5 typed lines of information.)
BLOCK 90. SIGNATURE... This block must contain the sponsor's signature. (Signature is
required.)
Note: When the DD Form 1172 is not signed in the presence of the verifying official, the signature
must be notarized. The notary seal and signature should be placed in the right margin of
section III.
BLOCK 91. DATE SIGNED (YYYYMMMDD). Enter the date the sponsor signed the DD Form
1172.
SECTION IV - VERIFIED BY
BLOCK 92. TYPED NAME (LAST, FIRST, MIDDLE INITIAL). Enter the information
pertaining to the verifying official. (Use no more than 27 characters.)
BLOCK 93. PAY GRADE. Enter the pay grade of the verifying offi- cial. (Use no more than 4
characters.)
BLOCK 94. UNIT/COMMAND NAME. Enter the unit/command name for the verifying
official. (Use no more than 26 characters.)
BLOCK 95. TITLE. Enter the verifying official's title. (Use no more than 24 characters.)
BLOCK 96. UIC. Enter the unique identifier (UIC, PAS Code, RUC- MCC, OPFAC) for the
verifying office in the same manner as pre- scribed in block 19.
BLOCK 97. DUTY PHONE NUMBER. Enter the verifying official's duty telephone number.
(Use no more than 14 characters.)
BLOCK 98. UNIT/COMMAND ADDRESS (STREET, CITY, STATE, 9-DIGIT ZIP). Enter
the mailing address for the verifying official. (Use no more than 28 characters.)
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