USAGJForm1529.pdf

2. SPONSOR INFORMATION & ACCESS DESCRIPTION

3. VISITORS INFORMATION

1. INSTRUCTION

USAG-J FORM 1529, MAR 2012 PMPREVIOUS EDITIONS ARE OBSOLETE. V2.70

ONE TIME/MULTIPLE ACCESS ROSTER

DRIVER'S LICENSE NO.

NATIONALITY

PASSPORT NO.

VEHICLE

PLATE NO.

a. VISIT DAY b. VISIT TIME c. TOTAL (PERSONAL) d. TOTAL (VEHICLE) e. GATE NO.

ADDRESS & TELEPHONE NO.

PASSPORT NO. &

DRIVER'S LICENSE NO.

NAME (Last, First MI)

Page

g. TYPE OF REQUEST f. PURPOSE

j. SPONSOR'S SIGNATURE h. MULTIPLE ACCESS

EFFECTIVE DATE

i. MULTIPLE ACCESS

EXPIRATION DATE

b. RANK c. DUTY TELEPHONE NO. d. TELEPHONE NO. a. TYPED NAME (Last, First MI)

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 serves 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.

e. DESTINATION/INSTALLATION

ONE TIME MULTIPLE

Pagesof a.

b.

DATE OF REQUEST

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: 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.

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

ENGLISH ADDRESS

JAPANESE TEL

TOFROM

(yyyymmdd)

(yyyymmdd)

(yyyymmdd) (yyyymmdd)

ENGLISH ADDRESS

JAPANESE TEL

ENGLISH ADDRESS

JAPANESE TEL

ENGLISH ADDRESS

JAPANESE TEL

ENGLISH ADDRESS

JAPANESE TEL

DRIVER'S LICENSE NO.

PASSPORT NO.

DRIVER'S LICENSE NO.

PASSPORT NO.

DRIVER'S LICENSE NO.

PASSPORT NO.

DRIVER'S LICENSE NO.

PASSPORT NO.