Instructions For U-1201 - Request For Visit (Rfv) Form Page 2

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UNCLASSIFIED
REQUEST FOR VISIT (RFV) UNCLASSIFIED
ANNEX(ES)
ADMINISTRATIVE DATA
1.
REQUESTOR:
DATE: ________________________________________
Defense Security Service
International Division, Quantico, VA
VISIT ID: ______________________________________
AMENDMENT: _____
REQUESTING GOVERNMENT AGENCY OR INDUSTRIAL FACILITY
2.
CAGE CODE:
________________
NAME:
_________________________________________________________________________________
POSTAL ADDRESS:
________________________________________________________________________
CITY:
STATE:
ZIP CODE:
_____________________________________
________
________________
FAX NO.:
TELEPHONE NO.:
_____________________________
____________________________
POINT OF CONTACT:
______________________
EMAIL:_________________________________________________
GOVERNMENT AGENCY OR INDUSTRIAL FACILITY TO BE VISITED
3.
COUNTRY: ____________________________
NAME:___________________________________________________________________________________________________
POSTAL ADDRESS: _______________________________________________________________________________________
__________________________________________________________________________________________________________
FAX NO.: __________________________________
TEL. NO.: _________________________________________
POINT OF CONTACT:
_______________________
________________________________________
EMAIL:
4. DATES OF VISIT:
TO
5.
TYPE OF VISIT:
SELECT ONE FROM EACH COLUMN
INITIATED BY REQUESTING AGENCY/FACILITY
GOVERNMENT INITIATIVE
6. SUBJECT TO BE DISCUSSED:
7.
ANTICIPATED LEVEL OF CLASSIFIED INFORMATION TO BE INVOLVED: _________________________________
8.
IS THE VISIT PERTINENT TO:
SPECIFY
A SPECIFIC EQUIPMENT OR WEAPON SYSTEM
_______________________________________________
FOREIGN MILITARY SALES OR EXPORT LICENSE
_______________________________________________
A PROGRAMME OR AGREEMENT
A DEFENSE ACQUISITION PROCESS
_______________________________________________
OTHER
_______________________________________________
9.
PARTICULARS OF VISITORS
VISITOR
#001
SSN:
_____________________
NAME:
___________________________________________________________________
DATE OF BIRTH:
____________________
PLACE OF BIRTH: _____________________________________
SECURITY CLEARANCE:
ID/PP NUMBER: _______________________________________
____________________
NATIONALITY: ________________________ POSITION: ____________________________________________
COMPANY/AGENCY:
___________________________________________________________________
VISITOR
#002
SSN: _________________________
NAME: ________________________________________________________________________________
DATE OF BIRTH: ________________________ PLACE OF BIRTH: _____________________________________
SECURITY CLEARANCE: ________________________ ID/PP NUMBER: _______________________________________
NATIONALITY: ________________________ POSITION: ____________________________________________
COMPANY/AGENCY: ________________________________________________________________________________
FORM U-1201
NOV 2014

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