Sample.pdf
PDF 612 KB Posted
- Attached to
- Elelectric Distribution System, YS18-73 Federal contract opportunity
- Solicitation number
- FA520917Q0031
About this file
Gate Pass Request Form Sample
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment_0003.pdf | ||
| PWS_Amend_3.1.pdf | ||
| Amend_0001_.pdf | ||
| Amendment_0002.pdf | ||
| PWS_Amend_2.pdf | ||
| PWS_YS73_27_Jul.pdf | ||
| PWS_YS73_27_Jul.pdf | ||
| Notice_to_Offeror.pdf | ||
| 17Q0031.pdf | ||
| Business_w_US_Government_AF_70th.pdf | ||
| Gate_Pass_Request_Form.pdf |
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Text version
ONE TIME/MULTIPLE ACCESS ROSTER
DATA REQUIRED BY THE PRIVACY ACT OF 1974
PMV2.70PREVIOUS EDITIONS ARE OBSOLETE.USAG-J FORM 1529, MAR 2012
1. INSTRUCTION
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
DATE OF REQUEST
of Pages
Title 10 U.S.C., Code, Section 3013.
To provide information to officials of the Army responsible for monitoring/controlling visitor's status.
Information is used to record and assign authorized pass numbers to allow authorized visitors onto U.S. Army installations.
voluntary. Failure to disclose the required information will result in authorized pass numbers not being issued; therefore, causing the applicants to have to meet and escort on and off the installation their visitors.
A "One Time/Multiple Access Roster" is valid for a single group visit for a specific date and time. It is the sole responsibility of the individual sponsor to include all information listed. Processing time can be reduced if each sponsor will take the time to legibly list the required information in both English and Kanji. This roster must be submitted to the Provost Marshal, USAG-J (APAJ-PM-MD-R), within four (4) working days of the proposed visit.
The sponsor's signature services as an acknowledgment the sponsor is aware of his/her individual responsibilities to exercise total control over his/her non -SOFA guests in accordance with the provisions contained in USAG-J Regulation 190-13.
a.
b.
a. TYPED NAME (Last, First MI)
e. DESTINATION/INSTALLATION
h. MULTIPLE ACCESS
EFFECTIVE DATE
f. PURPOSE
i. MULTIPLE ACCESS
EXPIRATION DATE
j. SPONSOR'S SIGNATURE
g. TYPE OF REQUEST
d. TELEPHONE NO.b. RANK c. DUTY TELEPHONE NO.
a. VISIT DAY
NATIONALITY NAME (Last, First MI) ADDRESS & TELEPHONE NO. PASSPORT NO. &
DRIVER'S LICENSE NO.
VEHICLE
PLATE NO.
e. GATE NO.d. TOTAL (VEHICLE)c. TOTAL (PERSONNEL)
FROM
b. VISIT TIME
ENGLISH ADDRESS PASSPORT NO.
JAPANESE TEL DIRVER'S LICENSE NO.
ENGLISH ADDRESS PASSPORT NO.
JAPANESE TEL DIRVER'S LICENSE NO.
ENGLISH ADDRESS PASSPORT NO.
JAPANESE TEL DIRVER'S LICENSE NO.
ENGLISH ADDRESS PASSPORT NO.
JAPANESE TEL DIRVER'S LICENSE NO.
ENGLISH ADDRESS PASSPORT NO.
JAPANESE TEL DIRVER'S LICENSE NO.
TO
Page
ONE TIME MULTIPLE
2. SPONSER INFORMATION & ACCESS DESCRIPTION
3. VISITORS INFORMATION
V2.70 263-7038
USAG-J FORM 1529
KANZAWA
ONE TIME/MULTIPLE ACCESS ROSTER
8 APR 15
Mar 2012
ONE TIME/MULTIPLE ACCESS ROSTER
DATA REQUIRED BY THE PRIVACY ACT OF 1974
PM
V2.70
PREVIOUS EDITIONS ARE OBSOLETE.
USAG-J FORM 1529, MAR 2012
1. INSTRUCTION
AUTHORITY: PRINCIPAL PURPOSE: ROUTINE USES: DISCLOSURE:
DATE OF REQUEST
of Pages Title 10 U.S.C., Code, Section 3013.
To provide information to officials of the Army responsible for monitoring/controlling visitor's status.
Information is used to record and assign authorized pass numbers to allow authorized visitors onto U.S. Army installations.
voluntary. Failure to disclose the required information will result in authorized pass numbers not being issued; therefore, causing the applicants to have to meet and escort on and off the installation their visitors.
A "One Time/Multiple Access Roster" is valid for a single group visit for a specific date and time. It is the sole responsibility of the individual sponsor to include all information listed. Processing time can be reduced if each sponsor will take the time to legibly list the required information in both English and Kanji. This roster must be submitted to the Provost Marshal, USAG-J (APAJ-PM-MD-R), within four (4) working days of the proposed visit.
The sponsor's signature services as an acknowledgment the sponsor is aware of his/her individual responsibilities to exercise total control over his/her non -SOFA guests in accordance with the provisions contained in USAG-J Regulation 190-13.
a.
b.
a. TYPED NAME (Last, First MI)
e. DESTINATION/INSTALLATION
h. MULTIPLE ACCESS EFFECTIVE DATE
f. PURPOSE
i. MULTIPLE ACCESS EXPIRATION DATE
j. SPONSOR'S SIGNATURE
g. TYPE OF REQUEST
d. TELEPHONE NO.
b. RANK
c. DUTY TELEPHONE NO.
a. VISIT DAY
NATIONALITY
NAME (Last, First MI)
ADDRESS & TELEPHONE NO.
PASSPORT NO. & DRIVER'S LICENSE NO.
VEHICLE PLATE NO.
e. GATE NO.
d. TOTAL (VEHICLE)
c. TOTAL (PERSONNEL)
FROM
b. VISIT TIME
ENGLISH
ADDRESS
PASSPORT NO.
JAPANESE
TEL
DIRVER'S LICENSE NO.
ENGLISH
ADDRESS
PASSPORT NO.
JAPANESE
TEL
DIRVER'S LICENSE NO.
ENGLISH
ADDRESS
PASSPORT NO.
JAPANESE
TEL
DIRVER'S LICENSE NO.
ENGLISH
ADDRESS
PASSPORT NO.
JAPANESE
TEL
DIRVER'S LICENSE NO.
ENGLISH
ADDRESS
PASSPORT NO.
JAPANESE
TEL
DIRVER'S LICENSE NO.
TO
Page
2. SPONSER INFORMATION & ACCESS DESCRIPTION
3. VISITORS INFORMATION
| NumericField1: |
| DateField1: |
| TextField1: |
| TextField2: Japan |
| TextField2: Japan |
| TextField2: SUZUKI, Osamu |
| TextField2: 鈴木 修 |
| TextField2: KOMATSU, Hideki |
| TextField2: 小松 英樹 |
| TextField2: 090-1234-5678 |
| TextField2: 1-2-3 Koyabe, Yokosuka-shi, Kanagawa |
| TextField2: 080-1234-5678 |
| TextField2: 5 |
| TextField2: 123456789123 |
| TextField2: TR1234567 |
| TextField2: 1-2-3, Fuchinobe-cho, Chuo-ku, Sagamihara-shi, Kanagawa |
| TextField2: SHINAGAWA |
501 NO 1234
| CheckBox1: 0 |
| CheckBox1: 0 |
| NumericField2: |
| TimeField1: |
| SignatureField1: |
File details come from the government source that posted it. Updated .