3_NTO Atch1_One Day Pass Request Form.pdf

PDF 902 KB Posted Feb 3, 2022

Attached to: FY22 Sidetrack Roadbed Maintenance at Tsurumi Fuel Terminal
Solicitation number: FA520922Q0018
Issued by: Department of the Air Force Pacific Air Forces

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7_FA520922Q00180001.pdf	PDF	Mar 1, 2022
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1_Policies Procedures for Business w U.S. Government.pdf	PDF	Feb 3, 2022
5_FA520922Q0018.pdf	PDF	Feb 3, 2022

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PRE-AUTHORIZED PASS REQUEST FORM

DBIDS registration must be completed to request for a Pre-Authorized pass.

Date:

From:

Command Official

From:

Requestor

Last Name First Name Middle Name

Unofficial

To: Visitor Control Center, Fleet Activities Yokosuka

Subj: REQUEST FOR PRE-AUTHORIZATION PASS FOR GUEST TO ENTER FLEET ACTIVITIES YOKOSUKA

Ref: (a) COMFLEACTINST 5530.9 series

Encl:

For Official

(1) Copy of Driver's License (if vehicle pass is required)

(2) Copy of Vehicle Title (if vehicle pass is required)

1. Per reference (a), it is requested that the guest(s) listed on back page be authorized entry to the base with an escort.

2. It will be one day visit for unofficial visits. I will constantly escort my guest while on-base.

3. I will ensure my guest complies with all rules and regulations established for Commander, Fleet Activities Yokosuka installations.

4. I understand that lack of information could be denial of my request.

5. I understand that my DBIDS registration must be completed and updated.

REQUESTOR’S INFORMATION (If Unofficial) Requestor’s Command Address (Not mailing address)

Requestor’s Rate/Pay Grade Tel (Work) Tel (Home)

DATE/TIME

Passes are limited to only one day, overnight staying on base is prohibited with this pass request.

Date of Visit Time (From) Time (To)

ACCESSING POST (Check one) ◆Please pick one of the gates where you want to escort from./Commercial vehicles must enter from Womble gate.

Main Gate Pedestrian Lane

Main Gate Vehicle Lane

Womble Gate Pedestrian Lane

Womble Gate Vehicle Lane

Ikego

PURPOSE FOR VISIT (If Official) SATELLITE (If Official)

Hakozaki Tsurumi Urago

POINT OF CONTACT (If Official) Name (Last) Name (First) Rank/Rate Tel

E-mail Address

✯ I understand I am responsible for the actions of the person above while on the base and for the return of the pass upon its expiration.

✯ I understand every guest must have one or a set of designated Identifications in order to access base.

I certify that I am authorized to sign on my command's behalf. (If Official)

Signature of Requestor/Command

Date:

From: Visitor Control Center, Fleet Activities Yokosuka

To: Requester

1. Returned, approved / disapproved.

Signature

Submit this request to VCC at least 3 business days prior to the guest’s arrival!!!

UPON COMPLETION

FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE

CFAY5532/24 (Rev. 1-21)

Takayuki.Fujita.JA Typewritten Text dd mmm yyyy

(CONSTANT ESCORT REQUIRED)

VISITOR DATA

◆The nations listed reference (b) are limited to enter base, please contact 243-5330/5125 for further information.

◆Unofficial request is up to ten guests. Official request is unlimited.

◆Private Organization is considered as Unofficial.

No. Last Name First Name Date of birth Nationality

U n o fficial G u ests L im it

U n lim ited fo r O fficial G u ests

VEHICLE DATA (Only for Official) ◆Copy of car title and driver’s license must be attached with this request ◆Driver’s Name must be on VISITOR DATA List also.

No. Vehicle Plate Number Driver’s Name

O n ly fo r O fficial

Submit this request to VCC at least 3 business days prior to the guest’s arrival!!!

UPON COMPLETION

FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE

CFAY5532/24 (Rev. 1-21)

DBIDS registration must be completed to request for a Pre-Authorized pass.

Date:

From:

Command Official From:

Requestor

Last Name First Name Middle Name Unofficial

To: Visitor Control Center, Fleet Activities Yokosuka

Subj: REQUEST FOR PRE-AUTHORIZATION PASS FOR GUEST TO ENTER FLEET ACTIVITIES YOKOSUKA

Ref: (a) COMFLEACTINST 5530.9 series Encl:

For Official

(1) Copy of Driver's License (if vehicle pass is required)

(2) Copy of Vehicle Title (if vehicle pass is required)

1. Per reference (a), it is requested that the guest(s) listed on back page be authorized entry to the base with an escort.

2. It will be one day visit for unofficial visits. I will constantly escort my guest while on-base.

3. I will ensure my guest complies with all rules and regulations established for Commander, Fleet Activities Yokosuka installations.

4. I understand that lack of information could be denial of my request.

5. I understand that my DBIDS registration must be completed and updated.

REQUESTOR’S INFORMATION (If Unofficial) Requestor’s Command Address (Not mailing address)

Requestor’s Rate/Pay Grade Tel (Work) Tel (Home)

DATE/TIME

Passes are limited to only one day, overnight staying on base is prohibited with this pass request.

Date of Visit Time (From) Time (To)

ACCESSING POST (Check one) Please pick one of the gates where you want to escort from./Commercial vehicles must enter from Womble gate.

Main Gate Pedestrian Lane

Main Gate Vehicle Lane

Womble Gate Pedestrian Lane

Womble Gate Vehicle Lane Ikego

PURPOSE FOR VISIT (If Official) SATELLITE (If Official) Hakozaki Tsurumi Urago

POINT OF CONTACT (If Official) Name (Last) Name (First) Rank/Rate Tel

E-mail Address

I understand I am responsible for the actions of the person above while on the base and for the return of the pass upon its expiration.

I understand every guest must have one or a set of designated Identifications in order to access base.

I certify that I am authorized to sign on my command's behalf. (If Official)

Signature of Requestor/Command Date:

From: Visitor Control Center, Fleet Activities Yokosuka

To: Requester

1. Returned, approved / disapproved.

Signature

Submit this request to at least 3 business days prior to the guest’s arrival!!!

UPON COMPLETION

FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE

CFAY553 /24 (Rev. 1-21)

DD MMM YYYY

NAVSUP FLCY Code700(Tsurumi or Hakozaki Fuel Terminal)

DD MMM YYYY XX:XX XX:XX

Delivery ✔ ✔

Shibusawa Eiji MLC 1-3 243-0123 eiji.shibusawa.ja@fe.navy.mil

Takayuki.Fujita.JA Typewritten Text

SIGN

Takayuki.Fujita.JA Highlight

Takayuki.Fujita.JA Text Box 各黄色ハイライト箇所とサインを入れて申請して下さい。 ☆入門の際に身分証明書の提示（必須）がありますので、忘れない様に、ご指導しておいて下さい。

(CONSTANT ESCORT REQUIRED)

VISITOR DATA

The nations listed reference (b) are limited to enter base, please contact 243-5330/5125 for further information.

Unofficial request is up to ten guests. Official request is unlimited.

Private Organization is considered as Unofficial.

No. Last Name First Name Date of birth Nationality

U nofficial G uests Lim it

U nlim ited for O fficial G uests

VEHICLE DATA (Only for Official)

Copy of car title and driver’s license must be attached with this request Driver’s Name must be on VISITOR DATA List also.

No. Vehicle Plate Number Driver’s Name

O nly for O fficial

Submit this request to VCC at least 3 business days prior to the guest’s arrival!!!

UPON COMPLETION

FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE

CFAY553 /24 (Rev. 1-21)

TOYOTOMI Hideo 01 Apr 1977 Japan

ODA Nobuto 25 Dec 1970 Japan TOKUGAWA Yasuhide 15 Jun 1989 Japan

Yokohama 100 ME 235 TOYOTOMI, Hideo

Takayuki.Fujita.JA Highlight

Takayuki.Fujita.JA Line

Takayuki.Fujita.JA Text Box 人だけの場合は他の添付はいりませんが、入門時には身分証明書（本籍等入り）の提示が必要になります。

Takayuki.Fujita.JA Line

Takayuki.Fujita.JA Text Box 車両入門が必要な場合は、車検証と運転免許証のコピーを添付して申請して下さい。

Takayuki.Fujita.JA Line

PURPOSE FOR VISIT If OfficialRow1:

Last Name1:

First Name1:

Date of birth1:

Nationality1:

Last Name2:

First Name2:

Date of birth2:

Nationality2:

Last Name3:

First Name3:

Date of birth3:

Nationality3:

Last Name4:

First Name4:

Date of birth4:

Nationality4:

Last Name5:

First Name5:

Date of birth5:

Nationality5:

Last Name6:

First Name6:

Date of birth6:

Nationality6:

Last Name7:

First Name7:

Date of birth7:

Nationality7:

Last Name8:

First Name8:

Date of birth8:

Nationality8:

Last Name9:

First Name9:

Date of birth9:

Nationality9:

Last Name10:

First Name10:

Date of birth10:

Nationality10:

Last Name11:

First Name11:

Date of birth11:

Nationality11:

Last Name12:

First Name12:

Date of birth12:

Nationality12:

Last Name13:

First Name13:

Date of birth13:

Nationality13:

Last Name14:

First Name14:

Date of birth14:

Nationality14:

Last Name15:

First Name15:

Date of birth15:

Nationality15:

Last Name16:

First Name16:

Date of birth16:

Nationality16:

Last Name17:

First Name17:

Date of birth17:

Nationality17:

Last Name18:

First Name18:

Date of birth18:

Nationality18:

Last Name19:

First Name19:

Date of birth19:

Nationality19:

Last Name20:

First Name20:

Date of birth20:

Nationality20:

Last Name21:

First Name21:

Date of birth21:

Nationality21:

Last Name22:

First Name22:

Date of birth22:

Nationality22:

Last Name23:

First Name23:

Date of birth23:

Nationality23:

Last Name24:

First Name24:

Date of birth24:

Nationality24:

Last Name25:

First Name25:

Date of birth25:

Nationality25:

Vehicle Plate Number1:

Drivers Name1:

Vehicle Plate Number2:

Drivers Name2:

Vehicle Plate Number3:

Drivers Name3:

Vehicle Plate Number4:

Drivers Name4:

Vehicle Plate Number5:

Drivers Name5:

Vehicle Plate Number6:

Drivers Name6:

DATE OF VISIT: dd mmm yyyy

FIirst name:

Last Name:

Middle name:

Sponsor Command: NAVSUP FLCY Code700 (Tsurumi Fuel Terminal)

Requestor's Command:

Address:

SP RATE:

TEL:

TEL_HOME:

FROM: XX:XX

TIME_TO: XX:XX

LNAME_POC:

FNAME_POC:

RANK: MLC

RATE:

TEL_COMMAND: 243-XXXX

TSURUMI: Yes

URAGO: Off

E-MAIL: ja@fe.navy.mil

MAIN_P: Off

MAIN_V: Off

Womble_p: Off

WOMBLE_V: Off

IKEGO: Off

Hakozaki: Off

File details come from the government source that posted it. Updated Feb 3, 2022.