Attachment 01_ 1-Day Official Entry-Exit Request.pdf

PDF 352 KB Posted Jan 31, 2023

Attached to: MCASI, Iwakuni FY23 Friendship Day
Solicitation number: M62613-23-Q-0005
Issued by: United States Marine Corps

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File	Type	Posted
Q_A M6261323Q0005.pdf	PDF	Feb 7, 2023
D1_Cover Sheet M6261323Q0005.pdf	PDF	Jan 31, 2023
D1_RFQ Combined Synopsis_M6261323Q0005_Redacted.pdf	PDF	Jan 31, 2023

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Name of Escorter : Grade: DoD ID#

Name of Sponsor : Grade: DoD ID#

Organization : TEL# RTD:

MM/YY

Destination: From: To:

Time / Date Time / Date

Purpose of Request:

**日本語で記入する場合、名前及び国籍は英語表記でも記入すること / You can fill out all in Japanese except guests name and nationality.

**17歳以下で親の同伴がない場合は承諾書が必要/ Children 17 years old or younger traveling without their parents need to attach signed “Permission Statement”

H-1

3) Facility access is contingent upon MCX and DECA policy and should be addressed with each facility directly.

4) Those guest(s) who attend club activities must check out and exit the Air Station within 30 minutes of respective club's closing.

5) A violation of this authorization may result in disciplinary action up to termination of sponsorship privilages.

Work / Cell Phone

ADDRESS, TEL#

(住所、電話番号)

PLACE OF

WORK

"For Official Use Only - Privacy Sensitive : Any misure or unauthorized disclosure may result in both civil and criminal penalties"

Approving Official

PRINT NAME

Sponsor's Signature

1) GUEST(S) MUST BE ESCORTED AT ALL TIMES WHILE ON THE INSTALLATION. PASS(ES) MUST BE RETURNED TO THE MAIN GATE SENTRY WHEN

YOUR GUEST(S) EXIT THE AIR STATION.

2) Your respective guest(s) must check in upon entering the Air Station and be issued a visitor's pass. A Vailed picture

I.D. is requred at Main Gate when checking in.

DOB(生年月日)DD/MM/YY,AGE (歳)

BADGE#

APPENDIX H MCASO 5500.2V

1-DAY OFFICIAL ENTRY/EXIT REQUEST Date:______________ (Must Submit to PMO Admin DURING WORKING HOURS 3 BUSINESS DAYS IN ADVANCE)

NATIONALITY

PASSPORT#

VEH#

PRINT NAME OF GUEST（氏名）

QTRS#

REVISION Ver.1(14Jan2016)

QTRS:

Organization:

RTD:

Destination:

Purpose of Request:

PLACE OF WORKRow1:

BADGERow1:

2_2:

PLACE OF WORKRow2:

VEHRow2:

BADGERow2:

3_2:

PLACE OF WORKRow3:

VEHRow3:

BADGERow3:

4_2:

PLACE OF WORKRow4:

VEHRow4:

BADGERow4:

5_2:

PLACE OF WORKRow5:

VEHRow5:

BADGERow5:

6_2:

PLACE OF WORKRow6:

VEHRow6:

BADGERow6:

7_2:

PLACE OF WORKRow7:

VEHRow7:

BADGERow7:

8_2:

PLACE OF WORKRow8:

VEHRow8:

BADGERow8:

9_2:

PLACE OF WORKRow9:

VEHRow9:

BADGERow9:

10:

10_2:

PLACE OF WORKRow10:

VEHRow10:

BADGERow10:

PRINT NAME:

REQUEST Date:

escorter:

escorter Grade:

escorter DoD ID:

Sponsor name:

Sponsor Grade:

Sponsor DoD ID:

TEL:

cell:

From time:

From day:

To time:

To date:

vehicle:

nationality 1:

passport 1:

nationality 2:

passport 2:

nationality 3:

passport 3:

nationality 4:

passport 4:

nationality 5:

passport 5:

nationality 6:

passport 6:

nationality 7:

passport 7:

nationality 8:

passport 8:

nationality 9:

passport 9:

nationality 10:

passport 10:

add1:

add1-2:

add2:

add2-1:

add3:

add3-1:

add4:

add4-1:

add5:

add5-1:

add6:

add6-1:

add7:

add7-1:

add8:

add8-1:

add9:

add9-1:

add10:

add10-1:

1_2:

age 1:

age 2:

age 3:

age 4:

age 5:

age 6:

age 7:

age 8:

age 9:

age 10:

File details come from the government source that posted it. Updated Jan 31, 2023.