4_Foreign National Access Request Form v2.pdf
PDF 222 KB Posted
- Attached to
- FY24 MCON P-614 JOINT CONSOLIDATED COMMUNICATIONS CENTER, US JOINT REGION MARIANAS, ANDERSEN, GUAM
- Solicitation number
- N6274225R1303
About this file
This is a Foreign National Access Request Form used by the Department of the Air Force at Headquarters 36th Wing (PACAF), Andersen Air Force Base Guam, specifically for contractor requests. The form, modified on February 18, 2020, is designed to collect detailed information for up to four visitors requiring base access.
The form captures essential visitor information including first and last names, dates of birth, citizenship, identification type (passport, I-94, U.S. visa, or other), occupation, place of employment, relationship to escort, duration of stay, purpose of visit, and address while on Guam. It requires approval from both a Project Coordinator and Contracting Officer, and includes tracking numbers for contract and FVR (Foreign Visitor Request). The form includes a Privacy Act Statement indicating the information is used to determine access eligibility to the installation, with disclosure being voluntary but necessary for validation of identity and entry determination.
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Text version
Contractor Request
_________________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
DD / MMM / YYYY
DD / MMM / YYYY
DD / MMM / YYYY
Country of Citizenship:
Identification Type
[] Passport [] I-94 [] U.S. Visa [] Other:___________
[] Passport [] I-94 [] U.S. Visa [] Other:___________
[] Passport [] I-94 [] U.S. Visa [] Other:___________
[] 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.
File details come from the government source that posted it. Updated .