N4019220R1300_RFP Part A Attachment 3_NBG Foreign National Base Access Request Forms.pdf

NAVAL BASE GUAM

FOREIGN NATIONAL BASE ACCESS REQUEST

Completion of this form will be used solely for law enforcement and force protection purposes and will be handled according to pertaining laws and regulations. Every section of this form must be accurately completed and legible.

The information is necessary for validation of identity and determination of entry eligibility on to Naval Base Guam. Failure to provide this information may result in non-issuance determination by the issuing authority.

Sponsor Information

1. Name (Last, First, MI)_________________________________________________________

2. Status: Active Duty; Reserve; Retired; Military Dependent; Other: ________

3. Base Access Identification Card Number (i.e. DODID#):___________________________

4. Command/Unit/Company (or closest affiliation): __________________________________

5. Contact phone number and email address while on Guam: __________________________

6. Address/Residence/Lodging on Guam: ___________________________________________

*** A copy of the sponsor valid identification must be provided ***

Sponsor Signature:____________________________________ Date: ___________________

Visitor Information

7. Visitor Type: Sponsored Guest; Contractor; Other________________________

8. Full Name(s) of Visitor(s): ______________________________________________________

9. Country of Citizenship: ________________________________________________________

10. Contact Phone Number on Guam: ______________________________________________

11. Residence on Guam (include hotel room number if applicable): ______________________

12. Purpose of visit to Naval Base Guam Installation(s): ________________________________

13. Intended on Base Destination(s): _______________________________________________

14. Beginning and end time(s) requested for access to Naval Base Guam:

*** Copies of Passport, Visa and/or other valid identification are required for all sponsored visitors ***

-------------------------------------------FOR NBG VISITOR CONTROL CENTER----------------------------------

VCC staff that processed Name: __________________________________________________

VCC Staff (Printed Name)

Signature: ____________________________________ DATE: __________________________

FN BIOMETRIC DATA

APPLICANT DATA ENTRY (Filled in by applicant not sponsor information)

ROUTING CODE: DATE:

LAST NAME: FIRST NAME:

MIDDLE NAME: SUFFIX:

DATE OF BIRTH: SSN:

SEX: HEIGHT:

RACE: WEIGHT:

EYE COLOR: HAIR COLOR:

PLACE OF BIRTH: CITIZENSHIP:

REASON FOR BIO-DATA:

OCCUPATION:

APPLICANT’S CURRENT RESIDENCE ADDRESS

STREET:

CITY: STATE: ZIP:

EMPLOYER INFORMATION

EMPLOYER/COMPANY NAME:

STREET:

CITY: STATE: ZIP:

-----------------------------------------------FOR NBG VISITOR CONTROL CENTER-----------------------------------------------

Data Entry Completed by:

VCC Staff (Printed Name)

Data Entry Completed by: DATE:

VCC STAFF (Signature)

The information is necessary for validation of identity and determination of entry eligibility on to Naval Base Guam. Failure to provide this information may result in non-issuance determination by the issuing authority.