Attachment 6 Base Pass Request.pdf

DATE SUBMITTED:

NAME (Last, First, MI)

FULL SSN

(no dashes)

DRIVER LICENSE #

Ensure individuals bring the following items to the Visitor Control Center (1) Real ID Driver’s License (if not a REAL ID, need second form of valid ID), (2) Registration and (3) Proof of insurance

***THIS FORM IS TO BE FILLED OUT AND SIGNED BY SPONSOR (DoD CAC HOLDERS ONLY)***

Privacy Act Statement PRIVACY ACT-1974 as Amended applies – This memo may contain information which must be protected IAW DOD 5400-11, and it is For Official Use Only (FOUO)

AUTHORITY: 10 U.S.C. 8013; 44 U.S.C. 3101; and EO 93397 PRINCIPAL PURPOSES: Used to record information and details of criminal activity which may require investigative action by commanders, supervisors, police, special agents, etc. ROUTINE USES: Information may be disclosed to Pass and Registration to determine base access. DISCLOSURE IS VOLUNTARY: SSN is used to positively identify the individual as a conduit to check past criminal activity records. Failure to provide the request information will affect your ability to gain access to

March Air Reserve Base, CA.

DL STATE

DOB

MMDDYEAR

This document contains CONTROLLED UNCLASSIFIED INFORMATION (CUI) that must be protected under the Freedom of Information Act (5 U.S.C. 552 and/or the Privacy Act of 1974 (5 U.S.C. 552a). Unauthorized disclosure or misuse of this PERSONAL Information may result in disciplinary action, criminal and/or civil penalties. Contents not be disclosed, discussed, or shared with individuals unless they have direct need-to-know in the performance of their official duties.

Deliver this document directly to the VCC in person or e-mail the VCC ORG e-mail box. Only digitally signed and encrypted e-mail's from a .mil e-mail address will be accepted. E-mails from personal e-mail addresses will not be accepted.

**LISTS OF 10 OR MORE MUST BE SUBMITTED A MINIMUM OF 10 DUTY DAYS PRIOR TO VISIT**

**LISTS OF 9 OR LESS MUST BE SUBMITTED A MINIMUM OF 5 DUTY DAYS PRIOR TO VISIT**

Visitor Control Center Org e-mail: 452SFS.March.VCC@us.af.mil

452nd Security Forces Squadron Visitor Control Center March ARB Contractor Base Pass Request Sheet

TO

LOCATION:

COMPANY NAME:

START DATE:

VALID DAYS: M T W TH F SA SU

VALID TIMES:

EXPIRATION DATE:

Sponsor (DoD CAC Holder) Rank, Name, Unit/ORG:

Sponsor Contact Numbers (On-base & cell):

Sponsor E-Mail Address (.mil):

Date:Signature:

Controlled by: AFRC Controlled by: 452 SFS/S3L CUI Category: PRVCY Distribution/Dissemination Controls: FEDCON POC: MSgt Mark Estorga, DSN 447-3791

CUI

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