DC Term Ren IP by 8gobJ6

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									                                                        7220
                                                        Date

From:   LCDR John L. Doe, DC, USN, XXX-XX-6789/2200
To:     Chief, Bureau of Medicine and Surgery (M1C1)
Via:    Commanding Officer, USS EVERSAIL (CV-35)

Subj:   TERMINATION AND RENEGOTIATION OF ACTIVE DUTY AGREEMENT
        FOR DENTAL CORPS INCENTIVE PAY (IP)

Ref:    (a) OPNAVINST 7220.17
        (b) NAVADMIN _________

1. I hereby apply for Dental Corps Incentive Pay (IP) effective
______________ per references (a) and (b). If currently being
paid under the Legacy Dental Special Pays my VSP and current ASP
contract, or if being paid under the Consolidated Special Pays my
current IP contract dated _________________will be terminated as
of _______________. I shall repay the unearned portion of this
IP contract incident to award of IP for the new contract.

2.   Condition of the agreement.   I understand that:

    a. The year of continuous active duty that I agree to serve
will be effective on __________________.

    b. Dental Corps Incentive Pay (IP) in the amount of $________
for the specialty of _____________ and with an effective date of
_________________, may not be paid before approval of this
agreement by Chief, Bureau of Medicine and Surgery (BUMED M1C1).

    c. Chief, Bureau of Medicine and Surgery (M1C1) may terminate
this agreement for any reason enumerated in reference (a).

    d. In the event of termination, I must repay unearned IP on a
pro rata basis per reference (a).

    e. Termination of IP does not, in itself, relieve me of
requirements to complete statutory and educational service
obligations.

3. Point of contact for special pays is HM2 John W. Doe at
___________, DSN__________



                                   JOHN L. DOE

								
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