OFICINA NACIONAL DE SEGURIDAD Seguridad Industrial

OFICINA NACIONAL DE SEGURIDAD
Seguridad Industrial
REQUEST FOR VISIT
One-time
Recurring
Emergency
Amendment
Access to UNCLASSIFIED / RESTRICTED information or
to areas of limited access.
Annexes:
Access to information classified CONFIDENTIAL or above.
1. ADMINISTRATIVE DATA
Requestor:
SP-NSA
Date:
To:
dd / mm / yyyy
Reference:
2. REQUESTING FACILITY
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
3. FACILITY TO BE VISITED
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
4. DATE OF VISIT:
From:
dd / mm / yyyy To:
dd / mm / yyyy
5. TYPE OF VISIT: (select one from each column)
Government initiative
Initiated by the requesting Facility
Commercial initiative
By invitation of the Facility to be visited
6. SUBJECT TO BE DISCUSSED/JUSTIFICATION
7. ANTICIPATED LEVEL OF CLASSIFIED INFORMATION INVOLVED
(-----Indicate level-----)
8. THE VISIT IS PERTINENT TO:
Specific equipment or Weapon Systems
Foreign sales (dual-use or military equipment)
Programme or Agreement
Defence acquisition process
Other
SPECIFY
Yes
No
OFICINA NACIONAL DE SEGURIDAD
Seguridad Industrial
9. VISITOR DETAILS
Name:
Date of birth: dd / mm / yyyy
Security Clearance level: (-----Indicate level-----)
Position:
Company/Government Entity:
Place of birth:
Passport/ID Nº:
Nationality:
Name:
Date of birth: dd / mm / yyyy
Security Clearance level: (-----Indicate level-----)
Position:
Company/Government Entity:
Place of birth:
Passport/ID Nº:
Nationality:
10. SECURITY OFFICER OF THE REQUESTING FACILITY
Name:
Signature:
Tel/Fax Nº:
e-mail:
Stamp:
11. SECURITY CLEARANCE CERTIFICATE
(only for access to information classified CONFIDENTIAL or above or to areas of limited access, unless otherwise stated in
the corresponding Bilateral / Multilateral Agreement.)
Name:
Address:
Signature:
Stamp:
12. REQUESTING NSA/DSA
Name:
Address:
Signature:
13. REMARKS
Stamp:
OFICINA NACIONAL DE SEGURIDAD
Seguridad Industrial
Annex 1 to Request for Visit form
3. FACILITY TO BE VISITED
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
Name:
Address:
e-mail:
Telex / Fax Nº:
Tel:
Point of Contact:
(Continue as necessary)
OFICINA NACIONAL DE SEGURIDAD
Seguridad Industrial
Annex 2 to Request for Visit form
9. VISITOR DETAILS
Name:
Date of birth: dd / mm / yyyy
Place of birth:
Security Clearance level: (-----Indicate level-----)
Passport/ID Nº:
Position:
Nationality:
Company/Government Entity:
Name:
Date of birth: dd / mm / yyyy
Place of birth:
Security Clearance level: (-----Indicate level-----)
Passport/ ID Nº:
Position:
Nationality:
Company/Government Entity:
Name:
Date of birth: dd / mm / yyyy
Place of birth:
Security Clearance level: (-----Indicate level-----)
Passport/ID Nº:
Position:
Nationality:
Company/Government Entity:
Name:
Date of birth: dd / mm / yyyy
Place of birth:
Security Clearance level: (-----Indicate level-----)
Passport/ID Nº:
Position:
Nationality:
Company/Government Entity:
Name:
Date of birth: dd / mm / yyyy
Place of birth:
Security Clearance level: (-----Indicate level-----)
Passport/ID Nº:
Position:
Nationality:
Company/Government Entity:
Name:
Date of birth: dd / mm / yyyy
Place of birth:
Security Clearance level: (-----Indicate level-----)
Passport/ID Nº:
Position:
Nationality:
Company/Government Entity:
(Continue as necessary)