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

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