Attachment 16 - (CUI) BAL Template 21 SEP 2022.docx

CUI

DEPARTMENT OF THE AIR FORCE

17TH Training Wing (AETC) Goodfellow Air Force Base Texas

DD Month YYYY

MEMORANDUM FOR 17 SFS/S5

FROM: 17 CONS/PKA

SUBJECT: Request Unescorted Base Access Pass

I am sponsoring the following Non-ID card holding guest requiring Unescorted access to the base for (state official purpose, i.e. briefing animal safety, construction work, etc..).

The following contractor or guest will need periodic access to deliver lumber to the building. (Just an example…state your particular needs) Name DOB State/DL or ID# Last 4 SSN Date(s) of Entry Days/Hours Public, John Q. 20 Apr 1933 TX 12345678 0000 10 May – 15 Jun 2019 Mon – Thurs/0700-1500 I will ensure Mr. Public is briefed that only properly licensed visitors, appropriately covered by vehicle insurance, will operate a vehicle on Goodfellow AFB. Authorized vehicle operators will have in their possession a valid driver’s license, current vehicle registration and a valid insurance certificate at all times when operating a vehicle on the installation.

Upon completion or termination of this visitor request, I will ensure his pass is returned to the Visitor Control Center.

5. If you have any questions, please contact me at (325) 654-1234 and at cell phone number (325) 000-0000. (Your contact number must include your office number and cell phone number)

Controlled by: (Office creating doc) CUI Category: PRVCY Limited Dissemination control: FEDCON POC: (Person Creating Doc and phone number)

Ever Into Danger

CUI

image1.png