VA Form 21-0788, Information Regarding Apportionment of Beneficiary's Award Completed Form Examples and Samples
View detailed, filled-out examples of VA Form 21-0788, Information Regarding Apportionment of Beneficiary's Award. Our samples provide a clear guide on how to complete the form correctly, helping estranged spouses and dependents demonstrate financial need to claim a portion of a veteran's benefits.
VA Form 21-0788 Example: Estranged Spouse with Dependent Child
How this form was filled:
This sample of VA Form 21-0788 is filled out by an estranged spouse on behalf of herself and a dependent child. It details the claimant's financial hardship by documenting income, expenses, and assets, and contrasts this with the veteran's known financial situation to justify the need for apportionment of the veteran's VA award.
Information used to fill out the document:
- Veteran's Name: John A. Smith
- Veteran's VA File Number: 987-654-321
- Veteran's Social Security Number: 111-00-2222
- Claimant's Name: Jane M. Doe
- Claimant's Relationship to Veteran: Estranged Spouse
- Claimant's Phone Number: 555-123-4567
- Claimant's Address: 456 Oak Avenue, Anytown, USA 54321
- Dependent Child's Name: Michael T. Smith
- Dependent Child's Date of Birth: 2018-06-15
- Date of Marriage: 2015-05-20
- Date of Separation: 2024-08-01
- Claimant Net Monthly Income: $1,500.00 (from part-time employment)
- Claimant Monthly Expenses - Rent: $1,250.00
- Claimant Monthly Expenses - Utilities: $220.00
- Claimant Monthly Expenses - Food: $550.00
- Claimant Monthly Expenses - Other: $325.00 (Transportation, Clothing, Medical)
- Claimant Total Monthly Expenses: $2,345.00
- Claimant Assets - Bank Account: $850.00
- Claimant Assets - Vehicle: $4,500.00 (2015 Honda Civic)
- Claimant Assets - Real Estate: $0.00
- Veteran's Estimated Monthly Income: $2,200.00 (Estimated VA Benefits)
- Veteran's Living Situation: Lives separately, specific expenses are unknown.
- Reason for Apportionment (Remarks): My husband, John A. Smith, and I separated on August 1, 2024. He provides no financial support for me or our dependent son, Michael. My monthly expenses significantly exceed my income from my part-time job. I am requesting an apportionment of his VA award to meet basic living needs for our child and myself.
- Signature Date: 2026-03-12
What this filled form sample shows:
- Clearly identifies the veteran, claimant, and dependent child, establishing the relationship.
- Provides a detailed breakdown of the claimant's monthly income and expenses to demonstrate financial hardship and need.
- Includes a complete declaration of the claimant's modest assets (bank account, vehicle).
- Offers a clear and concise justification in the 'Remarks' section for the apportionment request.
- Uses current dates and realistic financial figures for a compelling and accurate VA Form 21-0788 sample.
Form specifications and details:
| Form Name: | VA Form 21-0788, Information Regarding Apportionment of Beneficiary's Award |
| Use Case: | Estranged spouse with a dependent child requesting apportionment due to lack of financial support from the veteran. |
| Filing Party: | Claimant (Estranged Spouse) |
Created: February 10, 2026 11:38 PM
