8 Attch Gate Pass Request (USAG-J 1529).pdf
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ONE TIME/MULTIPLE ACCESS ROSTER
DATA REQUIRED BY THE PRIVACY ACT OF 1974
PMV2.80PREVIOUS EDITIONS ARE OBSOLETE.USAG-J FORM 1529, JUL 2018
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
k. 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 & DRIVER'S LICENSE NO. TELEPHONE NO. &
PASSPORT NO.
VEHICLE
PLATE NO.
GATE NO.
d. TOTAL (VEHICLE)c. TOTAL (PERSONNEL)
FROM
b. VISIT TIME
ENGLISH ADDRESS
PASSPORT NO.JAPANESE
TEL
DRIVER'S LICENSE NO.
TO
Page
ONE TIME MULTIPLE
2. SPONSOR INFORMATION & ACCESS DESCRIPTION
3. VISITORS INFORMATION
GATE 1 GATE 3 GATE 4 GATE 5/B
e. AREA(S) TO BE AUTHORIZED
ZAMA SGD SHA YND APC PIER6
GATE NO.
ENGLISH ADDRESS
PASSPORT NO.JAPANESE
TEL
DRIVER'S LICENSE NO.
GATE 1 GATE 3 GATE 4 GATE 5/B
GATE NO.
ENGLISH ADDRESS
PASSPORT NO.JAPANESE
TEL
DRIVER'S LICENSE NO.
GATE 1 GATE 3 GATE 4 GATE 5/B
GATE NO.
ENGLISH ADDRESS
PASSPORT NO.JAPANESE
TEL
DRIVER'S LICENSE NO.
GATE 1 GATE 3 GATE 4 GATE 5/B
GATE NO.
ENGLISH ADDRESS
PASSPORT NO.JAPANESE
TEL
DRIVER'S LICENSE NO.
GATE 1 GATE 3 GATE 4 GATE 5/B
j. SPONSOR'S ORGANIZATION
Kawakami Ammunition Depot ✔
15:009:3020190709
横田 太郎
(どちらか）
SAMPLE (記入例)
パスポート
運転免許証および国籍が確認できる公の書類、例：住民票
写真付きマイナンバーカードの場合は担当者に連絡ください。
ご持参いただく に記載されている情報と同じ情報を上記 に記載のこと。一文字も違わないこと。）
（対人 （対物） 乗り入れ車両の車検証原本 乗り入れ車両の自賠責保険原本 乗り入れ車両の任意保険証コピー
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