Att_(A)_Access_Request_Form.xlsx

ACCESS ROSTER

START END LAST NAME FIRST NAME MIDDLE NAME NATIONALITY ID NUMBER PLATE NO E/N SPONSOR UNIT/COMPANY PHONE # OF SPONSOR SPONSOR NAME PHONE # OF VISITOR REASON FOR VISIT

E-MAIL TO: usn.cldj.acj34.list.base-access-control-office@mail.mil

All non-military access requests and documents must be submitted no later than 1600 hrs, fourteen (14) working days (Mon - Sat) prior to the date access is required. Coalition Military access requests must be submitted no later than 1600 hrs, 48 hours (excluding Sundays) prior to the date access is required.

NOTE: For non-Uniformed Services and non-Government Services CAC holding U.S. members and Third Country Nationals, a copy of a government issues passport must be submitted with the Access Request Form.

For Local/Host Country Nationals, a copy of an official government issued ID must be submitted with the Access Request Form. Either an Access Badge Employment Questionnaire (for new badge requests & badge renewals) or an Access Questionnaire (for temporary access & official visits) must be submitted with the Access Request Form. An approved Exception to Policy Request must be obtained and submitted with the above listed documents if access is required prior to the 14 day notification requirement for non-military or 48 hour notification requirement for Coalition Military Forces.

-FAILURE TO SUBMIT PROPER DOCUMENTATION WILL RESULT IN A DELAY OR DENIAL OF YOUR REQUEST.

-FAILURE TO SUBMIT ACCESS REQUEST WITHIN THE PROPER TIME FRAME WILL RESULT IN A DELAY OR DENIAL OF YOUR REQUEST.

&"Courier New,Regular"Updated &D &T Destroy all previous versions &"Courier New,Bold"&20BASE ACCESS ROSTER &"Courier New,Regular"&12FOR OFFICIAL USE ONLY