MILITARY AIR PASSENGER/CARGO REQUEST
NOTE: Keep this data on file for two years after submission date.
1. SELECT APPLICABLE TRAVEL STATEMENT:
Direct support of operational forces engaged in combat or contingency peace-keeping operations directed NCA, or for
PRIORITY 1
emergency lifesaving purposes.
"Required use" travel or compelling operational considerations making commercial transportation unacceptable (within
PRIORITY 2
24 hours). Mission cannot be satisfied by any other mode of travel. Requester should provide a 2-hour window for
departure and arrival times to allow consolidation of missions per DoD Directive 4500.43.
Official business travel which when consolidated by JOSAC with other travelers, is more cost effective than commercial
air travel or official business travel on previously scheduled missions. Requester must provide at least a 2-hour window
PRIORITY 3
for departure and arrival times to allow consolidation of missions per DoD Directive 4500.43.
2. PURPOSE OF TRAVEL
a. PUJC
b. COMPLETE MISSION DESCRIPTION
CODE
3. TOTAL
c. PRIORITY 2 COMPELLING CONSIDERATIONS AND REASON COMMERCIAL TRAVEL UNACCEPTABLE
NUMBER
OF PAX
4. SENIOR TRAVELER
a. NAME (Last, First, Middle Initial)
b. GRADE/DV CODE
c. DUTY TITLE
d. BRANCH OF SERVICE
5. ADDITIONAL PASSENGERS (Note: Required only for DV 7 or higher)
a. NAME (Last, First, Middle Initial)
b. GRADE/DV CODE
c. DUTY TITLE
d. BRANCH OF SERVICE
6. DESIRED FLIGHT ITINERARY
b. DEPART DATE/TIME (Z)/MO/YR (+/- 2 hrs)
d. ARRIVE DATE/TIME (Z)/MO/YR (+/- 2 hrs)
a. DEPARTURE ICAO
c. ARRIVAL ICAO
(Example: 25/1200 DEC 98 (1400))
(Example: 25/1200 DEC 98 (1400))
KDAA
13/ 1200Z NOV 2016 (Desired)
KPOB
13/ 1300Z NOV 2016
(1) LEG 1
KPOB
13/ 1900Z NOV 2016 (Desired)
KDAA
13/ 2000Z NOV 2016
(2) LEG 2
(3) LEG 3
7. COST OF COMMERCIAL TRAVEL (Transportation, additional per diem, lost time, etc.)
a. LEG 1
b. LEG 2
c. LEG 3
d. TIMES NO. OF PASSENGERS
e. EQUALS TOTAL COST
300.00
300.00
3
1,800.00
8. CARGO TRANSPORTATION (Cargo acceptors and handlers are required at destination airfield.)
a. CARGO DESCRIPTION
b. LARGEST ITEM DIMENSIONS
c. HEAVIEST ITEM DIMENSIONS/WEIGHT
c. TOTAL WEIGHT
d. TOTAL CUBIC FEET
e. SPECIAL HANDLING REQUIREMENTS (Explain)
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DD FORM 2768, MAR 1998
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