NOMINEE CHECK LIST CIA RETIREMENT AND DISABILITY SYSTEM

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-03092A000100070009-2
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: May 14, 2001
• Sequence Number: 9
• Publication Date: May 6, 1965
• Content Type: FORM

Approved For Release 2001/07/28 : CIA-R1Ab{$$3%92A000100070009-2
NOMINEE CHECK LIST
CIA Retirement and Disability System
1.
Name:
2.
Age:
64
3.
Service Designation:
D
4.
Years of Agency
Service:
13.4
5.
Qualifying Service:
159
PIC]
0
6 May 1965
Months of qualifying service to date.
Subject performing qualifying service.
Subject certified under orders for qualifying
service assignment.
6. Service Agreement:
U
0
"Application for Membership in the Career Staff
of the CIA" to be used in lieu thereof.
"Nominee is overseas - Service Agreement will be
requested when nomination approved.
7. Date of 15th anniversary review
Form
4+-65 3100a (Test)
S E C R E T
25X1A9a
Approved For Release 2001/07/28 : CIA-RDP78-03092A000100070009-2
 25X1A
Approved For Release 2001/07/28 : CIA-RDP78-03092A000100070009-2
Approved For Release 2001/07/28 : CIA-RDP78-03092A000100070009-2