Form NAVCRUIT 1130/13 NAVCRUIT 1130/13 Enlistee Financial Statement

OMB NO: 0703-0020
Expires:

ENLISTEE FINANCIAL STATEMENT

The public reporting burden for this collection of information is estimated to average 33 minutes per response including the time for reviewing instructions, searching existing date sources, gathering
and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information
including suggestions for reducing the burden to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center
Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (0703-0020). Respondents should be aware that not withstanding any other provision of law, no person shall be subject to any penalty for
failing to comply with collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR ENLISTEE FINANCIAL STATEMENT TO THE ABOVE ADDRESS.
PRIVACY ACT STATEMENT

Authority. Title 5, USC, Section 301 establishes Departmental regulations. Title 10, USC, Section 503 provides information on enlistment, Section 504 provides information on persons
not qualified for enlistment in the armed forces, Section 508 establishes reenlistment qualifications and Section 12103 establishes Reserve components qualifications. and E.O. 9397
(SSN). SORN ID# N01130-1
Purposes. To provide recruiters with information concerning personal financial status and other individualized items which may influence the decision to select or not select an
individual for enlistment in the U.S. Navy. To provide historical data for comparison of financial status of current applicants with those selected in the past. To provide delayed entry
personnel with training modules and allow DON officials to use the Navy Applicant Management Information System (NAMIS) to conduct surveys and administer on-line screening tools
that identify whether the delayed entry personnel qualify for special operations programs and other high-priority programs.
Routine Uses. This information will be accessed by recruiters and DON officials with a need to know in support of requests for enlistment in the U.S. Navy. Information may also be
released to officials and employees of other departments and agencies of the Executive Branch of government, upon request, in the performance of their official duties related to the
management of quality military recruitment and the recruitment of Merchant Marine personnel.
The DoD `Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of records notices also apply to this system.
Disclosure. Voluntary. However, failure to provide the requested information may result in an inability to process you for enlistment.
I affirm that I have read, understand, and agree to the above Privacy Act Statement.

Signature of Applicant

Date

This financial statement is used only by authorized U.S. Navy personnel and shall be completed by all applicants with dependents enlisting or
reenlisting in the Regular Navy/Navy Reserve, or when required by instruction.
Applicants in DEP over 90 days are required to complete an updated financial statement prior to shipping to RTC Applicants who acquire dependents
while in DEP shall complete this financial statement prior to shipping to RTC. The signature of the spouse is mandatory unless the spouse resides
outside the local recruiting area.

2. Date of Birth

1. Applicant Name (Last, First, MI)

4. Date

3. Eligible Pay Grade

5. Applicant's Current Employer

5a. Employed Since

5b. Net Monthly Pay

6. Spouse's Current Employer

6a. Employed Since

6b. Net Monthly Pay

7. Other Applicant's/Family Sources of Income

7a. Employed Since

7b. Net Other Income

8. Total Family Net Income (5b+6b+7b)

9. Estimated monthly income, prior to taxes and deductions, shall be calculated based on the current Defense Finance and
Accounting Service (DFAS) Basic Pay Table found at www.dfas.mil/militarypay/militarypaytables.html.
Total estimated Navy Pay (based on gross basic pay for enlistment pay grade)

10. Number of Dependents
11. Housing: Rent

Own

AGE
Buying

Other

AGE

AGE

AGE

AGE

Explain

a. Do You Have a Savings Account
12. Savings and
Checking Assets: b. Do You Have a Checking Account

9a. Est. Gross Base Pay

AGE
11a. Monthly Housing Cost:

Yes

No

Current Balance:

Yes

No

Current Balance:
Yes

No

If yes, explain in block 16

13. Debt Payment b. Have you ever been late on any payment more than 30 days? Yes
History:
Yes
c. Do you have any liens or judgments pending against you?

No

If yes, explain in block 16

No

If yes, explain in block 16

No

If yes, explain in block 16

a. Have you ever filed for bankruptcy?

d. Do you have or ever had anything in collections?

Yes

For Official Use Only - Privacy Sensitive
NAVCRUIT 1130/13 (Rev. 4-2014)

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ENLISTEE FINANCIAL STATEMENT
14. Monthly Recurring Debt:
Category

Category

Amount Owed

Monthly Payment

Mortgage
Automobile Loan
Credit Card (1)
Credit Card (2)
Credit Card (3)
Credit Card (4)
Bank Loan (1)
Bank Loan (2)
Child Support / Alimony
Other Credit Debt

Totals

14a.

15. Monthly Living Expenses:
Expense Category

Monthly Expenditure

Remarks

Food
Clothing
Utilities ( Gas, Water, Electricity, Etc.)
Insurance ( Life , Home, Auto, Health, Etc.)
Child Care
Phone
Cellular Service
Television, Cable, Satellite, DSL, Service
Entertainment
Miscellaneous Fee's for Services
Medical Care and Prescriptions
Other Expenses ( Explain in Remarks)
Total from Block 14a
15a.

Total Monthly Living Expenses
16. Applicant's Remarks:
(if additional space is required,
continue on separate sheet of paper.)
17. Financial Stability Calculations:

Estimated Net Family Income (Add blocks 6b, 7b and 9a):
Total Living Expenses 15a:
Differential (+/-):

For Official Use Only - Privacy Sensitive
NAVCRUIT 1130/13 (Rev. 4-2014)

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ENLISTEE FINANCIAL STATEMENT
18. I certify that the information given in this statement is a true account of my financial obligations and that my dependents (line out as
appropriate) Do
/ Do Not
require any special medical attention/treatment.

Signature of Applicant

Signature of Spouse

Authenticating Recruiter ( Type / Print)

Signature of Recruiter

19. Command Representative Interview.
I have determined member is handling present personal and financial affairs in a mature, competent, and responsible manner; can meet
current and expected financial obligations with service pay; and I have counseled the member concerning potential problems that may be
experienced at the onset of enlistment relating to financial matters and the assignment to possible dependent restricted tours.

Signature of Command Representative

Rank / Title of Position

Date

20. Interviewers Comments / Recommendations

For Official Use Only - Privacy Sensitive
NAVCRUIT 1130/13 (Rev. 4-2014)

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