Visitor_Questionaire_-_V2.5_(New).docx

Foreign National Access Request Form Ver 2.5

Visitor’s Escort (If Escort is sponsored, complete Primary Sponsor block) Escort’s Sponsor Info (if required): (AD, Guard, Res, Civ)

First Name

Middle Name:

Last Name:

Date of Birth:

Contact Phone Number:

SSN:

Organization:

Home Address:

Street

First Name:

Middle Name:

Last Name:

Date of Birth:

Country of Citizenship:

Identification Type

[ ] Passport [ ] U.S. Visa [ ] Resident Card [ ] Other

[ ] Passport [ ] U.S. Visa [ ] Resident Card [ ] Other

[ ] Passport [ ] U.S. Visa [ ] Resident Card [ ] Other

Occupation:

Relationship to Escort:

How long is your stay on Guam?

Other:

Other:

Other:

Purpose of visit to Andersen?

Address while on Guam:

PRIVACY ACT STATEMENT: AUTHORITY: Title 5 USC Section 301, Departmental Regulation Principle Purpose: To implement AFI 31-201, Installation Security and 31-218, Air Force Motor Vehicle Traffic Supervision. ROUTINE PURPOSE: To request and record the issuance of a Visitor Pass when the use of another form is not authorized or specified. Failure to provide any information requested may result in non-issuance of the Visitor Pass. Disclosure of SSN is voluntary acceptance of these terms constitutes approval for a background check to be conducted as part of the request approval process. The information is necessary for validation of identity and determination of entry eligibility on to Andersen Air Force Base. Failure to provide this information may result in non-issuance determination by the issuing authority.