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)