4_Foreign National Access Request Form v2.pdf

PDF 250 KB Posted Jun 16, 2023

Attached to: FY24 MDA PROJECT 699 DEFENSE OF GUAM, INITIAL DEPLOYMENT, JOINT REGION MARIANAS, GUAM
Solicitation number: N6274223R1319
Issued by: Department of the Navy Naval Facilities Engineering Command

View the file

Other files

File	Type	Posted
5_Contractor Policy Update Memo.pdf	PDF	Jun 16, 2023
1_Base Access Request - Contractor Memo.pdf	PDF	Jun 16, 2023
3_Base Access Affidavit 2020.pdf	PDF	Jun 16, 2023
2_III Log.pdf	PDF	Jun 16, 2023

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

DEPA

RTMENT OF THE AIR FORCE

HEADQUARTERS 36TH WING (PACAF)

ANDERSEN AIR FORCE BASE GUAM

Foreign National Access Request Form

Contractor Request

APPROVED BY: __________________________CONTRACT TRACKING #: ___________________FVR NUMBER:________

_________________ PROJECT COORDINATOR CONTRACTING OFFICER

First Name

Last Name:

Contact Phone Number:

Email Address:

Organization:

Visitor’s intended location on Andersen:

Visitor 1 Visitor 2 Visitor 3 Visitor 4 First Name:

Last Name:

Date of Birth:

DD / MMM / YYYY

Country of Citizenship:

Identification Type

[] Passport [] I-94 [] U.S. Visa [] Other:___________

Occupation:

Place of Employment:

Relationship to Escort:

How long is your stay on Andersen AFB?

From:________/________/________

DD MMM YYYY

To:________/_________/_________

DD MMM YYYY

From:________/________/________

DD MMM YYYY

To:________/_________/_________

DD MMM YYYY

From:________/________/________

DD MMM YYYY

To:________/_________/_________

DD MMM YYYY

From:________/________/________

DD MMM YYYY

To:________/_________/_________

DD MMM YYYY

Purpose of visit to Andersen?

Address while on Guam:

Street

_________________________,, Guam _______ City Zip

Street

_________________________,, Guam _______ City Zip

Street

_________________________,, Guam _______ City Zip

Street

_________________________,, Guam _______ City Zip

PRIVACY ACT STATEMENT: AUTHORITY: Title 5 USC Section 301, Departmental Regulation Principle Purpose: To record personal information and determine access to the installation ROUTINE PURPOSE: To request and record the issuance of a Visitor Pass when the use of another form is not authorized or specified. Failure to provide any information requested may result in non-issuance of the Visitor Pass. Disclosure of information is voluntary acceptance of these terms constitutes approval for a background check to be conducted as part of the request approval process. The information is necessary for validation of identity and determination of entry eligibility on to Andersen Air Force Base. Failure to provide this information may result in non-issuance determination by the issuing authority.

Date Approved: _________________

Date Modified: 18 Feb 2020

Date Approved:

CONTRACT TRACKING:

APPROVED BY:

FVR NUMBER:

First Name:

CONTRACTING OFFICERFirst Name:

Last Name:

CONTRACTING OFFICERLast Name:

Contact Phone Number:

CONTRACTING OFFICERContact Phone Number:

Email Address:

CONTRACTING OFFICEREmail Address:

Organization:

CONTRACTING OFFICEROrganization:

Visitors intended location on Andersen:

CONTRACTING OFFICERVisitors intended location on Andersen:

CONTRACTING OFFICERVisitors intended location on Andersen_2:

Visitor 1First Name:

Visitor 2First Name:

Visitor 3First Name:

Visitor 4First Name:

Visitor 1Last Name:

Visitor 2Last Name:

Visitor 3Last Name:

Visitor 4Last Name:

undefined:

undefined_2:

undefined_3:

undefined_4:

DD MMM YYYYCountry of Citizenship:

DD MMM YYYYCountry of Citizenship_2:

DD MMM YYYYCountry of Citizenship_3:

DD MMM YYYYCountry of Citizenship_4:

Other:

Other_2:

Other_3:

Other_4:

Passport I94 US Visa OtherOccupation:

Passport I94 US Visa OtherOccupation_2:

Passport I94 US Visa OtherOccupation_3:

Passport I94 US Visa OtherOccupation_4:

Passport I94 US Visa OtherPlace of Employment:

Passport I94 US Visa OtherPlace of Employment_2:

Passport I94 US Visa OtherPlace of Employment_3:

Passport I94 US Visa OtherPlace of Employment_4:

Passport I94 US Visa OtherRelationship to Escort:

Passport I94 US Visa OtherRelationship to Escort_2:

Passport I94 US Visa OtherRelationship to Escort_3:

Passport I94 US Visa OtherRelationship to Escort_4:

From:

undefined_5:

From_2:

undefined_6:

From_3:

undefined_7:

From_4:

undefined_8:

To:

undefined_9:

undefined_10:

To_2:

undefined_11:

undefined_12:

To_3:

undefined_13:

undefined_14:

To_4:

undefined_15:

undefined_16:

Purpose of visit to Andersen:

Guam:

Guam_2:

Guam_3:

City:

Guam_4:

City_2:

City_3:

City_4:

Check Box1: Off

Check Box2: Off

Check Box3: Off

Check Box4: Off

Text6:

Text5:

Text7:

Text8:

Text9:

Text10:

Text11:

Text12:

Text13:

Check Box14: Off

Check Box15: Off

Check Box16: Off

Check Box17: Off

Check Box18: Off

Check Box19: Off

Check Box20: Off

Check Box21: Off

Check Box22: Off

Check Box23: Off

Check Box24: Off

Check Box25: Off

Text26:

Text27:

Text28:

Text29:

Text30:

Text31:

Text32:

Text33:

Text34:

Text35:

Text36:

File details come from the government source that posted it. Updated Jun 16, 2023.