NAME: _____________________________________________________________________________________________________

NIA #: _______________________________________ ROSTER #: ____________________________________________________

UNIT: ______________________________________________________________________________________________________

REASON FOR DROP: ____ Medical ____ Disciplinary ____ On Request ____ Involuntary

RECRUITING STATION (Baghdad, Basra, Mosul, Irbil) _____________________________________________________________

AGE: ____________ ETHNICITY (Sunni, Shiite, Kurd, Other): ___________________________________________________

MARRIED: ______ NUMBER OF CHILDREN: _____ PRIOR MILITARY SERVICE: ________________________

DATE ARRIVED AT KURKUSH:_____________________ FROM (CITY): _____________________________________

COMMENTS: _______________________________________________________________________________________________


FIRST ENDORSEMENT

COMPANY COMMNADER SIGNATURE PRINT NAME

BATTALION COMMANDER SIGNATURE PRINT NAME

CMATT APPROVAL:

The above named individual is released from Iraqi Army Citizen Service from the New Iraqi Army this 

_____ day of _____________ 2003. 

I authorize payment of $ ___________ for a monthly (prorated) salary and a $ ________ travel stipend.

Effective date of Release: _________________________

APPROVED BY:

NAME: ___________________________________________

RANK: ___________________________________________

SIGNATURE: _____________________________________
CMATT


Coalition Military Assistance Training Team
Tadji, Iraq

DROP REQUEST FROM

NIA IDENTIFICATION CARD