Dd Form 2402 - Civil Aircraft Hold Harmless Agreement (Page 2 of 2) in pdf

PRIVACY ACT STATEMENT

AUTHORITY: 49 U.S. Code, Section 44502(d).

PRINCIPAL PURPOSE(S): Indicates certification by an individual or corporation to hold the U.S. Government harmless in

consideration of permission granted for the operation of civil aircraft into military aviation facilities. Used in conjunction with DD

Forms 2400 and 2401. It is maintained indefinitely.

ROUTINE USE(S): None.

DISCLOSURE: Voluntary; however, failure to provide this information will result in an individual or corporation being unable to

operate civil aircraft into a military aviation facility.

5. REMARKS

(If additional space is required, continue here. Refer to item number.)

Aircraft Type:

Call Sign / Tail Registration Number:

Airfield Of Origin:

Name / SSN / Date of Birth / Drivers License Number and State of all Souls On Board:

Aircraft Insurance Information:

Insurance Company:

Policy Number:

Effective Date:

Expiration Date:

Pilot's Personal Phone Number and E-Mail Address:

INSTRUCTIONS

1. Form must be filed along with DD Forms 2400 and 2401 to obtain a civil aircraft landing permit.

2. Complete all applicable items and submit to appropriate addresses in Note 2 below.

3. If the user is a corporation/company, all blocks must be completed and the form must be signed by two different corporate

officers. If the user is an individual, only Items 2b and 4 should be completed.

4. Original, handscribed signatures are required. Signature stamps, camera copied signatures, or any type of facsimile signatures

are unacceptable.

5. This form is available under DefenseLINK, Publications.

ARMY

NAVY

AIR FORCE

NOTE 2

COMMANDER

NAVAL FACILITIES

HQ USAF/A30-AC

ENGINEERING COMMAND

USAASA, ATTN: ATAS-AS

1480 AIR FORCE PENTAGON RM 5E857

CODE: REAT

BLDG 1466

WASHINGTON, DC 20330-1480

WASHINGTON NAVY YARD

9325 GUNSTON RD, SUITE N319

(703) 697-5967

1322 PATTERSON AVE. S.E., SUITE 1000

FT BELVOIR, VA 22060-5582

WASHINGTON, DC 20374-5065

(703) 806-0686

(202) 685-9202

DD FORM 2402 (BACK), JAN 2008

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Dd Form 2402 - Civil Aircraft Hold Harmless Agreement Page 2

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