Attachment B AUTEC Access Form.docx

Unclassified visit

U.S. Domestic Visits - Unclassified All personnel visiting AUTEC for unclassified, official business purposes must complete a visit request using DISS If your activity does not have access to DISS, send requested information on Company Letterhead, signed by the Facility Security Officer (FSO). Visitors may not sign their own visit requests. Letters must contain the information noted below and can be sent via fax 561-671-2857 Attn: WPB Security or U.S. mail to: NUWCDETAUTEC, 801 Clematis St Suite #1, WEST PALM BEACH FL 33401-5105.

· Visitor's full name:

· Date of Birth:

· Place of Birth:

· Citizenship:

· Purpose of Visit:

· Dates of Visit:

· POC/Sponsor at AUTEC:

· Test Number (if applicable):

· Organization you are representing:

· Name/Tel number of POC at organization (individual signing your visit letter):

· Passport Number:

· Passport country of issuance:

· Passport date of expiration: