Gate_Pass_Request_Form.pdf
PDF 991 KB Posted
- Attached to
- Ground Maintenance, Hiroshima Federal contract opportunity
- Solicitation number
- FA520918Q0026
About this file
Gate Pass Request Form
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| PWS_1_Mar_18.pdf | ||
| Appendix_C_revised_22_Feb.pdf | ||
| 18Q0026_Amend_0001.pdf | ||
| Business_w_US_Government.pdf | ||
| Appendix_C.pdf | ||
| PWS.pdf | ||
| 18Q0026.pdf | ||
| Notice_to_Offeror.pdf |
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Text version
2. SPONSOR INFORMATION & ACCESS DESCRIPTION
3. VISITORS INFORMATION
1. INSTRUCTION
USAG-J FORM 1529, MAR 2012 PMPREVIOUS EDITIONS ARE OBSOLETE. V2.70
ONE TIME/MULTIPLE ACCESS ROSTER
DRIVER'S LICENSE NO.
NATIONALITY
PASSPORT NO.
VEHICLE
PLATE NO.
a. VISIT DAY b. VISIT TIME c. TOTAL (PERSONAL) d. TOTAL (VEHICLE) e. GATE NO.
ADDRESS & TELEPHONE NO.
PASSPORT NO. &
DRIVER'S LICENSE NO.
NAME (Last, First MI)
Page
g. TYPE OF REQUEST f. PURPOSE
j. SPONSOR'S SIGNATURE h. MULTIPLE ACCESS
EFFECTIVE DATE
i. MULTIPLE ACCESS
EXPIRATION DATE
b. RANK c. DUTY TELEPHONE NO. d. TELEPHONE NO. a. TYPED NAME (Last, First MI)
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 serves 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.
e. DESTINATION/INSTALLATION
ONE TIME MULTIPLE
Pagesof a.
b.
DATE OF REQUEST
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY: 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.
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
ENGLISH ADDRESS
JAPANESE TEL
TOFROM
(yyyymmdd)
(yyyymmdd)
(yyyymmdd) (yyyymmdd)
ENGLISH ADDRESS
JAPANESE TEL
ENGLISH ADDRESS
JAPANESE TEL
ENGLISH ADDRESS
JAPANESE TEL
ENGLISH ADDRESS
JAPANESE TEL
DRIVER'S LICENSE NO.
PASSPORT NO.
DRIVER'S LICENSE NO.
PASSPORT NO.
DRIVER'S LICENSE NO.
PASSPORT NO.
DRIVER'S LICENSE NO.
PASSPORT NO.
| of: 1 |
| Pages: 1 |
| DATE OF REQUEST: 17 Feb 2017 |
| a TYPED NAME Last First MI: IGAKI, Kazuya |
| b RANK: BWT 1-7 |
| c DUTY TELEPHONE NO: 256-2523 |
| d TELEPHONE NO: |
| e DESTINATIONINSTALLATION: Kawakami & Akizuki AD |
| f PURPOSE: To attending the pre-bid meeting |
| h MULTIPLE ACCESS EFFECTIVE DATE: 22 Feb 2017 |
| i MULTIPLE ACCESS EXPIRATION DATE: 23 Feb 2017 |
| a VISIT DAY: |
| c TOTAL PERSONAL: 1 |
| d TOTAL VEHICLE: 1 |
| e GATE NO: |
| ADDRESS_2: |
| PASSPORT NO_2: |
| TEL_2: |
| DRIVERS LICENSE NO_2: |
| ADDRESS_3: |
| PASSPORT NO_3: |
| TEL_3: |
| DRIVERS LICENSE NO_3: |
| ENGLISH_4: |
| ADDRESS_4: |
| PASSPORT NO_4: |
| JAPANESE_4: |
| TEL_4: |
| DRIVERS LICENSE NO_4: |
| ENGLISH_5: |
| ADDRESS_5: |
| PASSPORT NO_5: |
| JAPANESE_5: |
| TEL_5: |
| DRIVERS LICENSE NO_5: |
| Check Box1: Yes |
| Check Box2: Off |
| b VISIT TIME FROM: 0900 |
| b VISIT TIME TO: 1600 |
| ESCORT: Escort: |
| ENGLISH_2: |
| JAPANESE_2: |
| ENGLISH_3: |
| JAPANESE_3: |
| JAPANESE_1: 広島 太郎 |
| TEL_1: 0823-23-1192 |
| DRIVERS LICENSE NO_1: |
| VEHICLE PLATE NO_1: Hiroshima |
55 ni
| NATIONALITY_1: JAPAN |
| ENGLISH_1: HIROSHIMA, Taro |
| ADDRESS_1: 5-1, Showa-machi, kure-shi, Hiroshima-ken |
| PASSPORT NO_1: |
| NATIONALITY_2: |
| NATIONALITY_3: |
| NATIONALITY_4: |
| NATIONALITY_5: |
| VEHICLE PLATE NO_5: |
| VEHICLE PLATE NO_2: |
| VEHICLE PLATE NO_3: |
| VEHICLE PLATE NO_4: |
| Text1: |
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