Mess Out Clearance

Last Name

* required

First Name

*required

Service Number

* required

CF One Number

Rank

Element

Date of Birth

ddmmyyyy

Current Residential Address

New Residential Address

Phone Number

E-mail

*required

Member Status

Reason for Out Clearance

Change of Strength Date (COS) Discharge Date

ddmmyyyy

Privacy Notice

I confirm that I have read the PRIVACY NOTICE.

Consent agreement

By registering to this program or activity, I consent to the collection and use of my personal information as described in the privacy notice above.