Attachment_0015_-_ASG-KU_Base_Access_Forms.pdf

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Enclosure 1A - Instructions for ASG-KU DES Form 190-16.01 (Access Applications- 01 Oct 2014)

INSTRUCTIONS FOR COMPLETING THE ASG-KU DES FORM 190-16.01

ENCLOSURE 1 – Required for all applicants requesting Access

Section I – Demographics:

Blocks 1 – 3: Last Name, First Name, and Middle Name/Suffix Self Explanatory Block 4: Passport Number and Expiration Self Explanatory Block 5: Foreign Identification Number

Kuwait Civil Identification Number or Country of Origin Identification Number

Block 6: Date of Birth

Block 7: Height Enter height in inches Block 8: Weight Enter weight in pounds Block 9: Gender Self Explanatory Block 10: Eye Color Self Explanatory Block 11: Hair Color Self Explanatory Block 12: Title/Position Enter exact Job Title Block 13: Rank/Grade i.e. GS-11E or Contractor Block 14: Citizenship/Nationality

Enter country of citizenship. If holds dual citizenship, the applicant must list BOTH countries Block 15: Race Enter one of the following:

A – Asian / Pacific Islander / anyone from the Asian continent or Pacific Islands B – Black N – Native American / Alaskan Native W – White / Caucasian / Anglo / European Descent U - Unknown

Block 16: Address Type Enter the type of address that will be listed in Blocks 17 –

Blocks 17 – 19: Address, City, State, Zip Code and Country

Enter the address of the type checked in Block 16 Block 20: Home Phone Number

Enter the Land Line Phone Number (if applicable) Block 21: Mobile Phone Number

Block 22: Work Phone Number

Enter phone number of the applicant’s work or office Block 23: DSN Phone Number

Enter DSN Number (if applicable)

Section II – Access Information

Block 24: Purpose of Application

Mark the box that applies to the applicant Blocks 25 – 27: Work Hours, Dates Requested and Work Days

Section III – Company/Contract Information

Block 28: Employer

Enter the primary company that the applicant is employed with Block 29: Department/Section

Enter the Department and/or Section of the applicant is assigned to Block 30: Work Location of Employee

Enter the location where the applicant works, i.e. Building Number, Zone Location, etc Block 31: Project Name/Task Order Enter all information as applicable Blocks 32 – 33: Supervisor Name and Work Number

Enter the name of the applicant’s immediate supervisor and the contact number Block 34: US Military Contract Number

Enter the complete contract number Block 35: Contract Expiration Date

Block 36: Contract Period

Base year of contract plus option years (i.e. Contract expires 30Sep2011, plus 3 option years: Expiration 30Sep2014) Block 37: Primary Contract Company

Enter the Primary Contract Company Name Block 38: Primary Contract Company Contact Information

Enter Telephone number, email and/or mailing address of Primary Contract Company Block 39: Name of Primary Contract Company Representative

Print name of individual that can be contacted for questions concerning the contract Block 40: Signature of Primary Contract Company Representative

Signature of individual who has reviewed application for Prime Contractor Block 41: Subcontract Number (If applicable) Block 42: Point of Contact (POC) for Subcontract Company (if applicable)

Section IV – Appointed Authority (AA) Information and Recommendation

Blocks 43 – 49: AA Last Name, First and Middle Name, Rank/Grade or Equivalent, Unit/Organization, Work Number, Mobile Number and E-Mail Address

Enter the information for the Directorate/Contracting Officer Representative (COR) for the applicant.

Block 50: Signature and Date

The signature must be of the individual listed in Blocks 43

– 49, must be original and match the Signature Card the IAO has on file.

Block 51: Areas of Access

Mark those areas the applicant is authorized to have access to based on the terms of the contract or orders. The AA must initial all areas required. Then line through all areas not authorized. (AA initials required).

Block 52: Personnel Access during FPCON Indicate Charlie or Delta access and initial. Delta access requires Enclosure 2C Block 53: Vehicle Privileges Indicate Yes, OR No if Applicant is authorized driving privileges. In order to request driving privileges during FPCON Delta Enclosure 2C must accompany the application. (AA Initial is required)

Enclosure 1A - Instructions for ASG-KU DES Form 190-16.01 (Access Applications- 01 Oct 2014)

Block 54 Escort Privileges Mark whether or not individual has escort privileges (AA initials required). OCNs require Enclosure 7, BATS Enrollment and DES Approval.

Block 55: AA Recommended IA Badge Expiration

Date COR/AA recommends IA Badge to expire (AA initials required)

Section V – Installation Access (IA) Card Holder Acknowledgement

Blocks 56 – 59: Names (Printed), Signature and Date

Applicant must read and acknowledge IA Card Holder Responsibilities, then print, sign and date before IA Card can be issued

Section VI – Access Office Use Only

Blocks 60 – 73: DO NOT WRITE IN THIS AREA

Section VII – Screening Office Use Only

Blocks 74 – 76: DO NOT WRITE IN THIS AREA

ADDITIONAL INFORMATION:

1. If you are a Western Contractor, DES recommends you begin your renewal process with Installation Access 30 days before the expiration date of your IA card.

2. If you are a Foreign National Contractor, DES recommends you begin your renewal process with Installation Access 45-60 days before the expiration of your IA card.

3. All Foreign Nationals must have an interview by the ASG-KU S2/CI BATS Combined Screening Team (CST) prior to being processed for access.

4. All signatures and initials of Company and COR/AA must be present on the application before anyone can be processed for access.

5. The applicant is responsible to provide all documents IAW Enclosure 2 at the time of processing or the application will be denied.

6. Original Passport must be presented at the time of processing.

7. Escorted Access Requests must be turned in 3 business days in advance for processing.

8. Contractor CAC TDY requests are recommended to be turned in 72 hours in advance for processing

9. Exceptions to Policy may require additional screening and/or interview.

10. Exceptions to Policy may take an extended period to process depending on the authority (US Military) that must approve it.

NON-ESCORTED ACCESS ROSTER (NEAR)

*(Must be on Company Letterhead)*

Enclosure 2D – Non-Escorted Access Roster (NEAR) 48 Hour Memo (Revision 3 – 01 Oct 2014)

DATE:

TO: Area Support Group – Kuwait (ASG-KU)

ATTN: Director of Emergency Services (DES) / Installation Access

Request that the following individual be authorized NEAR access (Specify with or without Vehicle Privileges during NEAR Access (List Specific Dates during Requested Period) :

1.) NAME (Last, First, Middle):

2.) Passport Number:

3.) Kuwait Civil ID #:

I hereby confirm that the above employee will be required to perform their job duties as [list job title] while on the NEAR. Their job duties include: [provide justification below].

Directorate/Company/Project Manager Signature

(Please ensure that the Signature Block includes Full Name, Title, Company Name, Signature and Date)

Requesting Authority (COR) Signature

Name, Rank/Grade, Unit/Organization, Signature and

Date)

DES USE ONLY APPROVED / DISAPPROVED

Enclosure 2 of the ASG-KU DES SOP

REQUIRED SUPPLEMENTAL DOCUMENTS GUIDE – ENCLOSURE 2

(Revision 15 – 01 Oct 2014)

Required Supplemental Documentation Checklist by Person Category This documentation must be submitted to the Installation Access Office (IAO) at the time of processing.

- If, for any reason the Application packet is missing any of the required documents or the copies are not legible, the packet will be rejected. -

- All information on SPOT LOA, Travel Orders or Enclosure 2B of DES SOP must be current and correct. -

1. U.S. Permanent Contractors: Those individuals with a valid U.S. Passport scheduled to be in Kuwait more than 90 days in a 365 day period. This includes those employed on a Host Nation / Coalition Forces Government Contract within the Kuwait Theater of Operations (KTO) but outside of ASG-KU Installations:

a. Enclosure 1- ASG-KU DES Form 190.16.01 completed and signed by COR / Appointed Authority.

b. Original passport must be presented at the time of badging.

c. Copy of passport photo and data pages.

d. Copy of SPOT LOA, Travel Orders or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

e. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP), if applicable.

f. Copy of valid U.S. Driver’s License, International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on an Entry Visa (Visa 14). Copy of valid Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on a Visa 17 / 18 if requesting Vehicle Privileges.

- WITH EITHER -

g. Copy of Entry Visa or Kuwait entry stamp. (Applicants will only be given an IA Badge for the length of the Entry Visa (Visa 14) up to a maximum of 90 days from entry).

- OR -

h. Copy of Visa 17 / 18 Residency page from passport. (IAW Host Nations Labor Laws and KMOD Guidance, applicants must apply for a Kuwait Residency if employed in Kuwait on a Military Installation for more than 90 days in a 365 day period).

2. U.S. Military / DoD Civilian CAC Registration: IAW the Installation Access and Vehicle Registration Policy, all U.S. Military / DoD Civilians are required to register their CAC as part of the in-process to the KTO.

a. Copy of orders / amendments.

b. Original CAC must be presented at time of DBIDS registration.

c. The above is required for initial registration as well as renewal.

3. Command Sponsored Active Duty U.S. Military / DoD Civilians (those authorized IA Badges):

a. Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by self.

b. Original CAC must be presented at time of DBIDS registration.

c. Copy of valid U.S. Driver’s License or International Driver’s Permit (IDP), if requesting Vehicle Privileges.

d. U.S. Military require a memorandum approved by the IA NCOIC. DoD Civilians are required to be on a DES approved memorandum list. If not, they must provide an Off Base Housing Memo (stamped and signed by a member of the Directorate of Installation Services (DIS)) or have their orders stamped and signed by DIS. This includes TDY personnel,

e. Renewals require the same documentation as initial IA Badge requirements.

4. Command Sponsored Active Duty U.S. Military / DoD Civilian Dependents (those authorized IA Badges):

a. For Dependents 13 years and older:

1) Enclosure 1- ASG-KU DES From 190-16.01 completed and signed by Command Sponsored U.S. Military / DoD Civilian Sponsor.

2) Clear copy of Active Duty U.S. Military / DoD Civilian’s IA Badge.

3) Copy of orders / amendments. Orders must clearly state that dependents are Command Sponsored to be considered as such.

4) Copy of passport photo and data pages.

5) Copy of active Kuwaiti Visa.

b. For Dependents 12 years and younger:

1) Copy of passport photo and data pages.

2) Clear copy of Active Duty U.S. Military / DoD Civilian’s IA Badge.

3) Copy of orders / amendments. Orders must clearly state that dependents are Command Sponsored to be considered as such.

4) Copy of active Kuwaiti Visa

5) Required dates of access.

**** NOTE: The above is required to be submitted to the IA NCOIC / Designate for Dependent Access Memo issuance NLT 72 hours in advance of access period. ****

5. Other Country Nationals from New Zealand, Australia, Canada or the United Kingdom (England, Ireland and Scotland):

a. Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by COR / Appointed Authority.

b. Original passport must be presented at time of badging.

c. Copy of passport picture and data pages.

d. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

e. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP), if applicable.

f. Copy of valid International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on an Entry Visa (Visa 14). Copy of valid Kuwait/ Gulf Cooperation Council (GCC) Driver’s License if on a Visa 17 / 18 if requesting Vehicle Privileges.

g. Copy of Entry Visa or Kuwait entry stamp. (Applicants will only be given an IA Badge for the length of the Entry Visa (Visa 14) up to a maximum of 90

h. Copy of Visa 17 / 18 Residency page from passport. (IAW Host Nations Labor Laws and KMOD Guidance, applicants must apply for a Kuwait Residency if employed in Kuwait on a Military Installation for more than 90 days in a 365 day period).

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

7) through Installation Access, ASG-KU CI, and to the DES. ****

6. Other Country National (OCN) Initial IA Badge requests (if on a Visa 14):

a. Enclosure 7- Exception to Policy Form completed and signed by COR / Appointed Authority and routed through the DES for approval.

b. Enclosure 3- Company Justification Memo signed by Prime Project / Deputy Project Manager requesting access to ASG-KU Installations for a non- U.S. Contractor without the benefit of a Kuwait Civil ID number.

c. Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by COR / Appointed Authority.

d. Original passport must be presented at the time of badging.

e. Copy of passport photo and data pages.

f. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

g. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP), if applicable.

h. Copy of valid International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

i. Copy of Entry Visa or Kuwait entry stamp. (Applicants will only be given an IA Badge for the length of the Entry Visa (Visa 14) up to a maximum of 90

**** NOTE: OCN Initial IA Badge requests (if on a Visa 14) cannot be renewed until Visa 17 / 18 issuance (Kuwait Civil ID Number). ****

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

7. Other Country National (OCN) Renewal IA Badge Requests (once Visa 17 / 18 and Civil ID Number have been issued from #6 above):

c. Copy of passport picture and data pages.

d. Copy of Visa 17 / 18 from passport.

e. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

f. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP), if applicable.

g. Enclosure 2A- Company Request for KCID Background Investigation Check completed and signed by Prime Company Project / Deputy Project Manager.

h. Copy of Kuwaiti Visa Sponsor’s Active Kuwait Chamber of Commerce and Industry (KCCI) registration with barcode.

g. Copy of valid Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

8. Other Country National (OCN) Initial IA Badge Requests (if on a Visa 17 / 18):

c. Copy of passport picture and data pages.

d. Copy of Visa 17 / 18 from passport.

e. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

f. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP), if applicable.

g. Enclosure 2A- Company Request for KCID Background Investigation Check completed and signed by Prime Company Project / Deputy Project Manager.

h. Copy of Kuwaiti Visa Sponsor’s Active Kuwait Chamber of Commerce and Industry (KCCI) registration with barcode.

i. Copy of valid Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

9. Other Country National (OCN) Renewal IA Badge Requests:

c. Copy of passport picture and data pages.

d. Copy of Visa 17 / 18 from passport.

e. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

f. Copy of Sub-Contracting LOI (Enclosure 2B if DES SOP), if applicable.

g. Enclosure 2A- Company Request for KCID Background Investigation Check completed and signed by Prime Company Project / Deputy Project Manager.

h. Copy of Kuwaiti Visa Sponsor’s Active Kuwait Chamber of Commerce and Industry (KCCI) registration with barcode.

i. Copy of valid Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

10. Other Country National (OCN) with Valid U.S. Permanent Resident Card (USCIS Form I-551):

c. Copy of passport picture and data pages.

d. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

e. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP) if applicable.

f. Copy of valid International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on an Entry Visa (Visa 14). Copy of valid Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on a Visa 17 / 18 if requesting Vehicle Privileges.

g. Copy of Entry Visa or Kuwait entry stamp. (Applicants will only be given an IA Badge for the length of the Entry Visa (Visa 14) up to a maximum of 90

h. Copy of Visa 17 / 18 Residency page from passport. (IAW Host Nations Labor Laws and KMOD Guidance, applicants must apply for a Kuwait Residency if employed in Kuwait on a Military Installation for more than 90 days in a 365 day period).

i. Original Valid U.S. Permanent Resident Card (USCIS Form I-551) must be presented at time of badging.

j. Copy of Valid U.S. Permanent Resident Card (USCIS Form I-551).

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

11. Other Country National (OCN) Joint Access Badge (ASG-KU / AFCENT Installations)

a. Enclosure 1B- Kuwait OCN Joint Installation Access Application completed and signed by individual Base Command.

c. Copy of passport picture and data pages.

d. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

e. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP) if applicable.

f. Enclosure 2A- Company Request for KCID Background Investigation Check completed and signed by Prime Company Project / Deputy Project Manager.

g. Copy of valid International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on an Entry Visa (Visa 14). Copy of valid Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on a Visa 17 / 18 if requesting Vehicle Privileges.

h. Copy of Entry Visa or Kuwait entry stamp. (Applicants will only be given an IA Badge for the length or the Entry Visa (Visa 14) up to a maximum of 90

i. Copy of Visa 17 / 18 Residency page from passport. (IAW Host Nations Labor Laws and KMOD Guidance, applicants must apply for a Kuwait Residency if employed in Kuwait on a Military Installation for more than 90 days in a 365 day period).

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

12. U.S. Embassy- Kuwait, Office of Military Cooperation Kuwait (OMCK) or Department of State (DoS) Personnel (U.S. Citizens): U.S. personnel assigned to the U.S. Embassy- Kuwait, DoS or in U.S. Diplomatic or consular posts are approved by the ASG-KU Commander to receive an Installation Access badge including their dependents.

a. Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by Appointed Authority or self if U.S. Government employee.

b. Copy of U.S. Embassy Badge or Orders stating Embassy Affiliation (whichever applies).

c. Copy of valid U.S. Driver’s License, International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

**** NOTE: For dependents 12 years and younger, refer to [4, b] above. ****

13. U.S. Embassy- Kuwait, Office of Military Cooperation Kuwait (OMCK) or Department of State (DoS) Personnel (Non- U.S. Citizens): Those Non- U.S.

personnel assigned or associated with the U.S. Embassy- Kuwait, DoS or in U.S. Diplomatic or consular posts and have been approved by the ASG-KU Commander (Exception to Policy).

a. Enclosure 7- Exception to Policy Form completed and signed by Appointed Authority and routed through the DES / ASG-KU Commander for approval.

b. Enclosure 3- Company Justification Memo signed by Prime Project / Deputy Project Manager requesting access to ASG-KU Installations for a non- U.S. Embassy Employee. Must state purpose for access.

c. Enclosure 1- ASG-KU DES Form 190.16.01 completed and signed by Appointed Authority.

d. Copy of U.S. Embassy Badge.

e. Original passport must be presented at time of badging.

f. Copy of passport picture and data pages.

g. Copy of Visa 17 / 18 from passport.

h. Copy of SPOT LOA or Prime Contracting Company LOI (Enclosure 2B of DES SOP).

i. Copy of Sub-Contracting Company LOI (Enclosure 2B of DES SOP), if applicable.

j. Copy of valid International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on an Entry Visa (Visa 14). Copy of Kuwait / Gulf Cooperation Council (GCC) Driver’s License if on a Visa 17 / 18 if requesting Vehicle Privileges.

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

14. Host Nations Government Agency (Kuwait Citizens):

a. Enclosure 1- ASG-KU DES Form 190.16.01 completed and signed by Appointed Authority.

b. Original Kuwait Civil ID must be presented at time of badging,

c. Copy of Kuwait Civil ID (front and back).

d. Copy of valid Kuwait Driver’s License if requesting Vehicle Privileges.

e. Copy of Kuwait Government ID Card (KMOI, KMOD, etc…).

f. Application must be approved by ASG-KU Host Nations (stamp).

g. Application must be approved by ASG-KU DES (stamp).

15. Host Nations Government Agency (Non Kuwaiti Citizens. Must have Visa 17):

a. Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by Appointed Authority.

c. Copy of passport picture and data pages.

d. Copy of Visa 17 from passport.

e. Copy of valid International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

f. Copy of Kuwait Government ID Card (KMOI, KMOD, etc…).

g. Application must be approved by ASG-KU Host Nations (stamp).

h. Application must be approved by ASG-KU DES (stamp).

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

16. Kuwait / Gulf Cooperation Council (GCC) Contractors Initial / Renewal IA Badge Requests (Citizens of Kuwait, Qatar, UAE, Oman, Saudi Arabia and Bahrain):

b. Original Kuwait / Gulf Cooperation Council (GCC) Civil ID must be presented at time of badging.

c. Copy of Kuwait / Gulf Cooperation Council (GCC) Civil ID (front and back).

d. Copy of SPOT LOA or Prime Company LOI (Enclosure 2B of DES SOP).

e. Copy of Sub-Contracting LOI (Enclosure 2B of DES SOP), if applicable.

f. Enclosure 2A- Company Request for KCID Background Investigation Check completed and signed by Prime Company Project / Deputy Project Manager.

g. Copy of Sponsor’s Active Kuwait Chamber of Commerce and Industry (KCCI) registration with barcode (if applicable).

h. Copy of valid Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

17. Escorted Access List (EAL) (Must be submitted a minimum of 3 business days in advance for processing, may only be placed on EAL a maximum of 15 days every 90 days):

a. Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by any COR / Appointed Authority.

b. Copy of passport photo and data pages.

c. Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status) if requesting Vehicle Privileges.

d. Copy of Kuwait Entry Visa (Visa 14) or copy of Kuwait entry stamp from passport.

e. Copy Kuwait Visa 17 / 18 from passport.

**** NOTE: Those individuals with an expired IA Badge of less than 30 days will not be placed on the Escorted Access List (EAL). ****

**** NOTE: Escorted Access for personnel from a Country of Concern (CoC) will require additional time for KCID BI, BATS screening and Exception processing prior to being adding to the EAL. ****

18. Non-Escorted Access Roster (NEAR) (Must be submitted 45 days in advance for processing):

a. Must meet all requirements of appropriate individual requirements as listed in [1] or [5-10] above.

b. Enclosure 2D- Non-Escorted Access Roster (NEAR) 48 hr Memo.

c. Once approved, applicant will be placed on the NEAR and issued a NEAR IA Card.

19. U.S. Contractor CAC Holders Requiring Temporary Access (CAC TDY) (Will not exceed 90 days of access within a 365 day period from date of initial access):

a. Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by any COR / Appointed Authority.

b. Enclosure 3- Company Justification Memo stating nature of visit and Camps requested.

c. Original passport and CAC must be presented at time of badging.

d. Copy of passport photo and data pages.

e. Copy of CAC (front only).

f. Copy of SPOT LOA, Travel Orders or Prime Company LOI (Enclosure 2B of DES SOP).

g. Copy of Sub-Contracting LOI (Enclosure 2B of DES SOP), if applicable.

h. Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License if requesting Vehicle Privileges.

**** NOTE: Those individuals with an expired permanent IA Badge of less than 30 days will not be placed on CAC TDY status. ****

20. IA Badge Upgrades:

a. Vehicle Privileges Upgrade:

1) Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by COR / Appointed Authority

2) Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwaiti Visa status).

3) Enclosure 2C- FPCON DELTA Access Request if requesting DELTA Vehicle Privileges.

b. Escort Upgrade:

1) Enclosure 1- ASG-KU DES Form 190-16.01 completed and signed by COR / Appointed Authority.

**** NOTE: Escort privileges will not be granted to an OCN (Red Badge) unless applicant has filed and been granted an Exception to Policy (Enclosure

c. Additional Camps Upgrade:

d. FPCON DELTA Upgrade:

2) Enclosure 2C- FPCON DELTA Access Request.

**** NOTE: Upgrades will not be granted within 45 days of existing IA Card expiration. ****

21. Lost / Stolen IA Badges:

b. Copy of completed Military Police Report issued by Police Desk.

22. Vehicle Registration:

a. Transportation Motor Pool (TMP) Issued Vehicles:

1) Enclosure 4- ASG-KU DES Form 190-16.02 completed. Must be signed by COR / Appointed Authority if a Contractor vehicle (White Placard).

2) Original vehicle registration card.

3) Clear legible copy of vehicle registration card.

4) Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status) of Company Fleet Manager / Primary Driver (if a Contractor).

5) Upon renewal, a clear legible copy can be submitted in lieu of original vehicle registration card.

****NOTE: For U.S. Military / DoD Civilian operated vehicles (Green Placard), that are not TMP vehicles, refer to [22, a] and follow “TMP Issued Vehicle” procedures above. ****

b. Contractor Vehicles (Individual or fleets of 4 or less):

1) Enclosure 4- ASG-KU DES Form 190-16.02 complete and signed by COR / Appointed Authority.

2) Original vehicle registration card.

3) Clear legible copy of vehicle registration card.

4) Copy of lease / rental agreement (on leasing / rental company letterhead) stating vehicle(s) are leased / rented to a Company or separate copy of vehicle insurance in Companies name (on insurance company letterhead). Must list all applicable vehicles.

5) Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status) of Company Fleet Manager / Primary Driver.

6) Copy of IA Card of Company Fleet Manager / Primary Driver (front only) to verify vehicle privileges on the Installation, as defined on their IA Card.

7) Upon renewal, a clear legible copy can be submitted in lieu of original vehicle registration card

c. Contractor Vehicles (Fleets of 5 or more):

1) One Enclosure 4- ASG-KU DES Form 190-16.02 completed and signed by COR / Appointed Authority.

2) Spreadsheet identifying fleet vehicles with the following information; Full name of Fleet Manager, vehicle license plate number, vehicle VIN number, vehicle manufacturer, vehicle model, color of vehicle, year of vehicle and contract expiration date (base plus option years). This spreadsheet must be approved (signed) by COR / Appointed Authority.

3) Original vehicle registration cards of all vehicles.

4) Clear legible copy of vehicle registration cards of all vehicles.

5) Copy of lease / rental agreement (on leasing / rental company letterhead) stating vehicle(s) are leased / rented to a Company or separate copy of vehicle insurance in Companies name (on insurance company letterhead). Must list all applicable vehicles.

6) Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status) of Company Fleet Manager.

7) Copy of IA Card of Company Fleet Manager (front only) to verify vehicle privileges on the Installation, as defined on their IA Card.

8) Upon renewal, a clear legible copy can be submitted in lieu of original vehicle registration card.

**** NOTE: Fleets of 5 or more references in [22, c] above must have IA NCOIC / Designate approval (stamp) ****

d. Personally Owned Vehicles (POV) (For Company use):

1) Enclosure 9- Company – COR Authorization Letter for Vehicle (POV) completed and signed by Prime Project / Deputy Project Manager and COR/ Appointed Authority routed through the DES for approval. If individual works for a Sub-Contracting Company, Sub-Contracting Company Project / Deputy Project Manager must sign as well.

2) Enclosure 4- ASG-KU DES Form 190.16.02 completed and signed by COR / Appointed Authority.

3) Original vehicle registration card.

4) Clear legible copy of vehicle registration card.

5) Copy of lease / rental agreement (on leasing / rental company letterhead) or separate copy of vehicle insurance (on insurance company letterhead). Must list all applicable vehicles.

6) Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status) of vehicle owner.

7) Copy of IA Card of vehicle owner (front only) to verify vehicle privileges on the Installation, as defined on their IA Card.

8) Upon renewal, a clear legible copy can be submitted in lieu of original vehicle registration card

e. Personally Owned Vehicles (POV) (For personal use with access for all Camps to include Camp Arifjan):

1) Enclosure 7- Exception to Policy Form completed and signed by Appointed Authority and routed through the DES / ASG-KU Commander for approval.

2) Enclosure 3- Company Justification Memo signed by Prime Project / Deputy Project Manager providing justification for POV access to ASG-KU Installations. If individual works for a Sub-Contracting Company, Sub-Contracting Company Project / Deputy Project Manager must sign as well.

3) Enclosure 4- ASG-KU DES Form 190.16.02 completed and signed by COR / Appointed Authority.

4) Original vehicle registration card.

5) Clear legible copy of vehicle registration card.

6) Copy of lease / rental agreement (on leasing / rental company letterhead) or separate copy of vehicle insurance (on insurance company letterhead). Must list all applicable vehicles.

7) Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status) of vehicle owner.

8) Copy IA Card of vehicle owner (front only) to verify vehicle privileges on the Installation, as defined on their IA Card.

9) Upon renewal, a clear legible copy can be submitted in lieu of original vehicle registration card

f. Personally Owned Vehicles (POV) (For personal use with access for all Camps not to include Camp Arifjan):

1) Enclosure 4- ASG-KU DES Form 190.16.02 completed and signed by COR / Appointed Authority, routed through BSB-N PMO for approval.

2) Enclosure 3- Company Justification Memo signed by Prime Project / Deputy Project Manager providing justification for POV access to ASG-KU Installations. If individual works for a Sub-Contracting Company, Sub-Contracting Company Project / Deputy Project Manager must sign as well.

3) Original vehicle registration card.

4) Clear legible copy of vehicle registration card.

5) Copy of lease / rental agreement (on leasing / rental company letterhead) or separate copy of vehicle insurance (on insurance company letterhead). Must list all applicable vehicles.

6) Copy of valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status) of vehicle owner.

7) Copy of IA Card of vehicle owner (front only) to verify vehicle privileges on the Installation, as defined on their IA Card.

8) Upon renewal, a clear legible copy can be submitted in lieu of original vehicle registration card

23. Temporary Vehicle Access:

a. Escorted personnel:

1) EAL must state “Vehicle Authorized”.

2) Present original vehicle registration card.

3) Present valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status).

4) Temporary Vehicle Pass will be issued for the duration of approved escorted access

b. NEAR personnel:

1) NEAR badge must state driving privileges.

2) Present original vehicle registration card.

3) Present valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Country of Origin and Kuwait Visa status).

4) Temporary Vehicle Pass will be issued for the duration of approved NEAR access.

c. TDY (This includes U.S. Military / DoD Civilians and Contractors on TDY status):

1. U.S. Military / DoD Civilians must present TDY orders clearly stating they are authorized a vehicle while in Kuwait.

2. Contractor’s TDY IA Card must state driving privileges.

3. Present original vehicle registration card.

4. Present valid U.S., International Driver’s Permit (IDP) or Kuwait / Gulf Cooperation Council (GCC) Driver’s License (depending on customer’s Kuwait Visa status).

5. Temporary Vehicle Pass will be issued for the duration of approved TDY access.

d. Vehicle Change Out:

1. Present Vehicle Change-Out Form (loaner vehicle).

2. Present original vehicle registration card of loaner vehicle.

3. Present IA Card of vehicle operator to verify vehicle privileges on the Installation, as defined on their IA Card.

4. Temporary Vehicle Pass will be issued for the duration of the Vehicle Change-Out Form not to exceed 30 days.

**** NOTE: IAW DES SOP, Individuals / situations not previously addressed are not allowed access to the Installation ****

**** NOTE: Any requests for Exceptions to Policy will be routed through the DES / ASG-KU Commander. This process may require up to 45 days or more for approval, denial or clarification of request. ****

Enclosure 10 - ASG-KU DES FORM 190-16.05_Exception to Policy (17 Jul 2016)

Date:

Exception Type (Check All That Apply):

ASG-KU EXCEPTION TO POLICY FORM

AUTHORITY: AR 190-16, AR 600-8-14, AR600-8-104, USCENTCOM OPORD 10-05 Antiterrorism, AFR 207-4, OPNAVINST 5530.15a, MCO 5500.13a, DoD 1000.13p, ASG-KU Installation Access Policy.

PRINCIPAL PURPOSE: To evaluate an applicant requesting an exception to specific requirements of ASG-KU policies related to Installation Access.

ROUTINE USES: To establish a record for approval/disapproval of exception and to verify an applicant with an approved exception. Approved Prohibited Item Exceptions must be carried at all times while on any ASG-KU Installation and presented to military, law enforcement, or security personnel upon request.

DISCLOSURE REQUIREMENT - THIS INFORMATION IS VOLUNTARY: Failure to provide the documentation and information requested, including a Foreign Identification number, may result in the disapproval of this application. Exceptions may require additional screening, interview and background checks. Any derogatory information returned from the applicant's background investigation or failure to comply with screening/interview requirements may result in denial of exception and barment proceedings being initiated. Personal information such as Passport or Kuwait Civil ID number provide an individual with a unique identification and will be handled as OFFICIAL USE ONLY in accordance with Federal Statutes.

SECTION I - POLICY EXCEPTION REQUEST

Description of Exception Requested:

Applicant's Name: Title and/or Position:

Kuwait Civil ID Number: Passport Number: Date of Birth (DDMMMYY): Nationality

Company Name: Justification Memo Attached (Enclosure 7):

SECTION II - COR/AUTHORIZED SIGNATORY RECOMMENDATION

Rank, First and Last Name:

Signature:

Approved Exception Valid Until: Unit and Title:I am recommending the above exception and certify that I have verified the applicant's need and documentation for this exception.

SECTION III - IA OIC/NCOIC or DESIGNATE APPROVAL/DISAPPROVAL Title and/or Position:Approved Exception Valid Until:

Remarks:

Rank, First and Last Name: Signature:

SECTION IV - ASG-KU DES DIRECTOR APPROVAL/DISAPPROVAL

Approved Exception Valid Until: Title and/or Position:

SECTION V - ASG-KU COMMANDER APPROVAL/DISAPPROVAL

Approved Exception Valid Until: Title and/or Position:

Country of Concern Escort Request (Less than 72 hrs) POV Prohibited Items OCN Escort Privileges

Other ______________________________

Yes No

APPROVED

DISAPPROVED

Enclosure 7

Enclosure 6 - ASG-KU DES Form 190-16.14 (Revision 2 – 01 Oct 2014)

ASG-KU NOTICE OF DELEGATION OF AUTHORITY

(Read Privacy Act Statement and instructions before completing form)

DATE

PRIVACY ACT STATEMENT

AUTHORITY: AR 600-8-14, AR 600-8-104, and ASG-KU Installation Access Policy

PRINCIPAL PURPOSE: To establish positive identification and signature verification of all personnel authorized as signatories for ASG-KU Installation Access and Vehicle Registration.

MANDATORY DISCLOSURE REQUIREMENT: Failure to provide the below requested information, including last four digits of the social security number, will result in denial of delegated signatory privileges. Personal information such as the last four digits of the social security number provide an individual with a unique identification and will be handled as OFFICIAL USE

ONLY in accordance with Federal Statutes.

CONDITIONS APPLICABLE ON RECEIPT: I understand that the delegated signatory privileges requested by this document are valid only through the expiration date indicated.

COR/ ACO/ APPOINTING AUTHORITY

I assume full responsibility for the following as signatories for ASG-KU Installation Access and Vehicle Registration.

LAST NAME-FIRST NAME-MIDDLE INITIAL

LAST 4 OF SSN

GRADE

RANK

SIGNATURE

INITIALS

UNIT IDENTIFICATION CODE

DODAAC/ACCOUNT NUMBER

DOD COMPONENT/ORGANIZATION

SERVICE

ARMY NAVY USAF USMC US COAST GUARD

LOCATION

TELEPHONE NUMBER

EMAIL ADDRESS

AUTHORIZED REPRESENTATIVE(S)

CONTRACT NUMBER(S)

EXPIRATION

5. Foreign Identification Number: Expiration Date (dd/mmm/yy): 18. City, State, Zip code: 19. Country

6. Date of Birth (dd/mmm/yy): 7. Height (inches): 8. Weight (pounds):

Expiration Date (dd/mmm/yy): 17. Address Type:

20. Home Phone Number: 21. Mobile Phone Number:

ASG-KU ACCESS APPLICATION

Data Required by the Privacy Act of 1974 (5 USC 552a), DOD Directive 5400.11-R, 10 USC 3013, 10 USC 5013, 10 USC 8013 and Executive Order 9397

AUTHORITY: 10 U.S.C. 113, Secretary of Defense, Note (Use of Smart Card Technology in the Department of Defense); Directive-Type Memorandum (DTM) 09-012, Interim Policy Guidance for DoD Physical Access Control; 10 U.S.C. 136, Under Secretary of Defense for

Personnel and Readiness; DoD Directive 1000.25, DoD Personnel Identity Protection (PIP) Program; DoD Instruction 5200.08, Security of DoD Installations and Resources; DoD 5200.08-R, Physical Security Program; and E.O. 9397 (SSN), as amended.

PRINCIPAL PURPOSE(S): The records support DoD physical security and information assurance programs, to issue individual facility/installation access credentials, and for identity verification purposes. The system also is used to record personal vehicles and property registered with the DoD and for producing facility management reports. The records may be accessed by other physical access control systems for further verification at other sites. Records may also be used for law enforcement purposes.

ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a (b) of the Privacy Act of 1974, these records may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a (b) (3) as follows: Under DoD Blanket Routine Use #1. For law enforcement purposes to …federal, state, local, or foreign (law enforcement agencies), charged with enforcing or implementing the statute, rule, regulation, or order issued pursuant thereto. The DoD 'Blanket Routine Uses' set forth at the beginning of the OSD compilation of systems of records notices apply to this system.

DISCLOSURE REQUIREMENT – THIS INFORMATION IS VOLUNTARY: Voluntary. However, failure to provide the requested information may result in denial of a DBIDS card or visitor’s pass and denial of entry to DoD installations and/or facilities.

CONDITIONS APPLICABLE ON RECEIPT: I understand that the ASG-KU Installation Access (IA) Card is valid only through the expiration date indicated. Exceptions may require additional screening, interview and background checks. It should also be known that any derogatory information returned from the applicant's background investigation or failure to comply with screening/interview requirements may reflect adversely on consideration for access and may result in barment proceedings being initiated. Its intended use and authorizations are limited to those indicated on this form and the card. I understand that the ASG-KU IA Card is US Government property, that it is not transferable, that it is not to be altered in any way, and that it must be surrendered upon request of the US

Government, its designated representative, or the issuing agency. I understand that while on any ASG-KU Installation my person, possessions, vehicle and work area are subject to search at the discretion of the US Government or its designated representative. I understand that I am liable for the cost of replacement for my IA Card if lost. Any falsification on this form will result in immediate revocation of access privileges.

SECTION I - Demographics

1. Last Name (Surname) 12. Title/Position 13 Rank/Grade

14. Citizenship: If dual citizen list both 15. Race

3. Middle Name/Suffix: 16. Address (Building Name/Number, Street Name/Number, etc):

4. Passport Number:

2. First Name (Given Name)

SECTION II - Access Information

9. Gender: 10. Eye Color: 11. Hair Color: 22. Work Phone Number: 23. DSN Phone Number:

30. Work Location of Employee:

32. Supervisors Name:

34. US Military Contract Number:

37. Primary Contract Company:

24. Purpose of Application

25. Work Hours. 26. Dates Requested: 27. Work Days:

SECTION III - Company/Contract Information

28 Unit/ Employer: 29. Department and Section:

39. Name of primary Contract Company Representative:

31. Project Name/Task Order:

33. Supervisor Work Number:

38. Primary Contract Contact Information::

40. Signature of Primary Contract Company Representative:

42. Subcontract (POC):

35. Contract Expiration Dates (dd/mmm/yy) 36.Contract Period (Base plus option years):

41. Subcontract #:

From: To: From: To: From: To:From: To: From: To:

Organization AddressHome Address Company AddressOffice Address

Male Female

TDY Escort Request New Registration Renew Registration Upgrade of Privileges Lost / Stolen IA Card NEAR

Enclosure 1 - ASG-KU DES FORM 190-16.01-Access Application (Rev 2 - 01 Oct 2014)

Initial:

64. Vehicle Privileges: 65. Escort Privileges:

52. Personnel Access in FPCON : Initial:

51. Areas Of Access: Directorate/COR/AA must initial for each camp required.(Note Access is based on the individual’s need as stated in their contract. It is strictly prohibited to access areas not specified in their contract.)

Initial__________

48. AA Mobile Number:

50. AA Signature and Date:

46. AA Unit Organization: 47. AA Work Number:

49. AA Email Address:

54. Escort Privileges: Initial:53. Vehicle Privileges: Initial:

62. Expiration Date of IA Card (dd/mmm/yy)

74. Name of Screener: 75. Signature of Screener and Date: 76. Screening Status:

56. As a ASG-KU IA Card holder, I acknowledge the following:

1. All persons, their personal property, US Government property, and vehicles may be searched on entry, while within the confines of, or when leaving US Forces installations. Persons attempting to gain entry, who refuse to identify themselves, provide digitized fingerprint minutia data (DFMD), hand geometry scan, or consent to search, will be denied access.

2. If I am authorized escort privileges, I understand that I am agreeing to monitor that person’s actions at all times, and I accept full responsibility for that person’s conduct while on the installation.

3. IA Cards are US Government property. Any Military Police Officer, Law Enforcement, Security Force or Access Control personnel may confiscate an IA Card that has expired, is being used fraudulently, and is being presented by a person other than the person to whom it was issued, or is obviously altered, damaged, mutilated or photocopied.

4. I must surrender my pass when

a. It is replaced (except when lost or stolen).

b. I no longer require access.

c. My sponsor or status changes.

d. I resign, am terminated, or am no longer officially sponsored.

5. If I lose my IA Card or if it is stolen, I must immediately notify either the Law Enforcement Station or Installation Access Office. Failure to do so is grounds for denying a replacement card.

6. Violations of ASG-KU security policies may be grounds for denying access to US Forces Installations and lead to confiscation of all installation access documents.

57. (Print/Type) Last, First, MI: 58. Signature: 59. Date (dd/mmm/yy):

63. Personnel Access in FP

66. Areas, Gates, Base Privileges

SECTION VII - Screening Office Use Only

67. Category Classification:

68. Name of Person Entering Data/Collecting Biometrics: 69. Signature/Date of Person Entering Data/Collecting Biometrics: 70. DBIDS Number of Person Entering Data/Collecting Biometrics:

72. Vetting Date:

73. DBIDS Number of Applicant:

SECTION VI -Access Office Use Only

60. Name and Rank/Title of Person Approving Application: 61. Signature and Date of Person Approving Application

ASG-KU ACCESS APPLICATION

43. AA Last Name: 44. AA First and Middle Name: 45. AA Rank/Grade or Equivalent:

SECTION IV - Appointed Authority (AA) Information and Recommendation

SECTION V - Installation Access (IA) Card Holder Acknowledgement

55. AA Recommended IA Badge Expiration:

71. Supporting Documents Enclosed (if applicable)

* Copy of passport

* Enclosure 2A

* Copy of SPOT LOA or Enclosure 2B

* Enclosure 2C

* Enclosure 2D

* Enclosure 3

* Enclosure 7

* Copy of CAC (front only)

* Copy of Kuwait Entry Visa or stamp from passport

* Copy of Visa 17 / 18 from passport

* Copy of U.S. Driver's License or International Driver's Permit

* Copy of Kuwait / GCC Driver's License

* Copy of Kuwait Government ID Card (KU Govt Employees)

* Copy of U.S. Permanent Resident Card (USCIS Form I-551)

* Other ___________________________________________

Buehring

Arifjan

KNB/Patriot

SPOD

Charlie Delta w/ Enc 2C Yes No

Charlie Delta w/Enc 2C

Buehring

Arifjan KNB Patriot

SPOD

CAT 1 - OCN CAT 2 - Foreign Military CAT 3 - US Contractor CAT 4 - US Government CAT 5 - Commanders Exception

Approved Rejected Routed to DES

Yes No Delta w/ Enc 2C

Yes NoYes No Delta w/Enc 2C

OCN w/ Enc 3 and 7

Enclosure 1 - ASG-KU DES FORM 190-16.01-Access Application (Rev 2 - 01 Oct 2014)

ASG-KU VEHICLE REGISTRATION APPLICATION

SECTION I - VEHICLE INFORMATION

Type of Access:

Vehicle Identification Number (17 Digit Number): Vehicle Classification:

License Plate Number: Expiration of Vehicle Registration (DD-MMM-YY):Body Type:

Manufacturer's Name: Color: Name of Rental / Leasing Company or Owner:

Model Name: Contract Exp Date (For Fleet Veh): Name of Insurance Company:

Year of Vehicle: License Plate Issuing Country: Expiration of Insurance (DD-MMM-YY):

SECTION II - VEHICLE OWNER / PRIMARY DRIVER / FLEET MANAGER INFORMATION

Last Name: First, Middle Initial: Date of Birth (DD-MMM-YY):

Kuwait Civil ID Number / Passport Number:

Company / Unit: Phone Number:

SECTION III - COR / APPOINTED AUTHORITY (AA) INFORMATION AND RECOMMENDATION

AA Last Name: AA First, Middle Initial: AA Rank / Grade

AA Email Address: AA Signature and Date:

AA Unit / Organization: AA Work Number (DSN): AA Mobile Number:

SECTION IV - MOTOR VEHICLE OPERATOR ACKNOWLEDGMENT

Data Required by Privacy Act of 1974 (5 U.S. CODE 552a)

AA Recommended FPCON: AA Recommended Veh Exp Date (DD-MMM-YY):

Acknowledgement of ASG-KU Installation Motor Vehicle Operator Responsibilities

(Print) Last, First, MI: Signature: Date (DD-MMM-YY):

SECTION V - INSTALLATION ACCESS USE ONLY

Application Inspected By: Signature and Date of Person Approving Application: Expiration Date of Placard (DD-MMM-YY):

Name of person Entering Data: Signature and Date of Person Entering Data: DBIDS Number of Primary Driver:

Verified Documents Enclosed: Remarks:

Initials

As an ASG-KU Installation Motor Vehicle Operator, I…