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.
(If additional space is required, continue here. Refer to item number.)
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:
Pilot's Personal Phone Number and E-Mail Address:
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
5. This form is available under DefenseLINK, Publications.
USAASA, ATTN: ATAS-AS
1480 AIR FORCE PENTAGON RM 5E857
WASHINGTON, DC 20330-1480
WASHINGTON NAVY YARD
9325 GUNSTON RD, SUITE N319
1322 PATTERSON AVE. S.E., SUITE 1000
FT BELVOIR, VA 22060-5582
WASHINGTON, DC 20374-5065
DD FORM 2402 (BACK), JAN 2008