Application for Installation Access Credential 12 .pdf

DEPARTMENT OF THE AIR FORCE

502D AIR BASE WING

JOINT BASE SAN ANTONIO

Date

MEMORANDUM FOR 502 SFS/S5B

ATTN: Pass & Registration Office

FROM: 502 CES

2250 Engineer Street Suite 7 Fort Sam Houston TX 78234-7740

SUBJECT: Application for Installation Access Credential (AIAC)

1. The following company/organization is providing either vendor’s service or holds a contract with our organization. The individual is required to come to Ft Sam Houston on a regular basis. Therefore, this organization is requesting the issuance of access credential for ease of travel to and from the installation.

Company/Organization Contract/Service Number

Required Times/Days of Week

Required Dates

Full Address of Company/Organization

2. The below listed individual understands that this is an identification credential, not a sponsoring credential and that it will not allow entry into any facilities other than the installation gates. Use of this credential is strictly for business purposes only. Individual also agrees to adhere to all vehicle regulations and guidelines set forth by AFI 31-204, Air Force Motor Vehicle Traffic Supervision, and those set by the installation commander.

3. Upon termination of the contract, termination of the position, or expiration of the access credential, the holder agrees to return it to host contractor, sponsor, or building 260 (Registration Office) or any Visitor Control Center.

Name of Credential Holder Date of Birth SSN

Home Address

Vehicle Make Vehicle Model Year Color

Plate # State DL Number State

Registration Office Use Only Authorizing Official NCIC Printed Name

COPS/SFMIS Signature

FBI TWL Title

OFF INIT Duty Phone

SUP INIT Email

All requests must be submitted in person or via email to usaf.jbsa.502-sfs-fsh-visitor-control-cente@mail.mil NLT 5 days prior to the start date.

“FOUO, This document contains information exempt from mandatory disclosure under the FOIA. Title 5 U.S.C. 552 (b)(6) applies. This document also contains personal information that is protected by the Privacy Act of 1974 and must be safeguarded from unauthorized disclosure”