Physical Evaluation Board
Reference is made to the formal Physical Evaluation Board hearing that will
convene to consider my ________ case. The following statements indicate my wishes in
I will be present on _______when the Board considers this case. My
appearance will be at my own expense.
I do not wish to be present when the Board considers this case.
I request that (name of appointed counsel) represent ________
in this matter. His name and address are as follows:
I request the recorder arrange for the attendance of military witnesses whose
names and addresses are listed below. I understand that arranging for
the attendance of other witnesses and their expenses are my
(Signature of next of kin)
Figure 5-10. Form letter for NOK (legal guardian) acknowledgement
of receipt of notice for formal PEB hearing.