Attachment I Base Access Request Form.pdf

CAMP LEMONNIER

ENCL 10 BASE ACCESS REQUEST

DATE: _____________

From: _____________________________________________________________________________ To: CLDJ INSTALLATION SECURITY OFFICER Via: BASE ACCESS CONTROL OFFICE Subj: BASE ACCESS REQUEST

REASON FOR BASE ACCESS TO CLDJ INSTALLATION

APPROVAL ENDORSMENT

From: OIC (O-5 / GS14 or Above)

1. ___ Approved / ___ Disapproved Requester Digital Signature: ________________________________ Date: __________

Start Date: _________ End Date: _________

Instructions on submitting ENCL 10

1. Click “Attachments: View file attachments” (left-hand side)

2. Open ENCL 10 EXCEL Spreadsheet (right click & SAVE to Desktop)

3. Fill-in ALL Information Needed on EXCEL and SAVE

4. Complete “Reason for Base Access To CLDJ Installation" (below)

5. Must have OIC (O-5 / GS14 or Above) Digital Signature

6. Email ENCL 10 EXCEL AND PDF, (with signature) to the BACO distro list usn.lemonnier.nafdj-n3at.list.baase-access-control-office@mail.com

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ACCESS ROSTER

START END LAST NAME FIRST NAME MIDDLE NAME ID TYPE ID COUNTRY OF ISSUE ID NUMBER ESCORT OR NO ESCORT SPONSOR NAME SPONSOR UNIT/COMPANY PHONE # OF SPONSOR

National ID DJIBOUTI Escort Required

E-MAIL TO: usn.cldj.acj34.list.base-access-control-office@mail.mil

All access requests and documents must be submitted no later than 1600 hrs, FOURTEEN (14) working days (Mon - Fri) prior to the date access is required.

NOTE: For CAC holders, a copy of a government issued passport shall be submitted with the Access Request Form.

For Local/Host Country and Third Country Nationals, a copy of an official government issued ID or government issued passport shall be submitted with the Access Request Form.

National ID Escort Required

Passport No Escort Required

&"Courier New,Regular"Updated &D &T Destroy all previous versions &"Courier New,Bold"&20BASE ACCESS ROSTER &"Courier New,Regular"&12FOR OFFICIAL USE ONLY