"DC Term Ren IP"
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