DEPARTMENT OF DEFENSE

UNITED STATES OF AMERICA

93rd Ave, Abraham Dave street, Washington D.C. WA. U.S.A.
FORM 5656

APPLICATION FORM FOR FAMILY AND FRIENDS

Please complete this form correctly with black or blue ink

APPLICANT INFORMATION

FIRST NAME: _____________________________ MIDDLE NAME: ______________________________

LAST NAME: __________________________________________________________________________

ADDRESS: _____________________________________________________________________________

PHONE NUM: ___________________ SEX: ________________ RELATIONSHIP: ____________________

SERVICE MEMBER INFORMATION

FIRST NAME: _____________________________ MIDDLE NAME: _______________________________

LAST NAME: ________________________________ RANK: ___________________________________

COUNTRY DEPLOYED TO: ____________________________________________________________

NOTE: All applicants required to pay a processing fee of $420.00USD for processing

By, my signature, I hereby declare that every information provided in this family and friends form (G6)
is to best of my knowledge. My signature represents to comply with family and friends processing of
above named officer.

_________________________________ ___________________________
APPLICANT SIGNATURE DATE