Document Sample
					                                    VISITOR INFORMATION REQUEST- UK PLANTS ONLY
The following information is required to enable visitor(s) and their company(ies) visiting NORDAM sites to be screened to ensure UK, US, EU, and
Singapore laws and regulations regarding proprietary and intellectual property are protected. Screening will also meet the regulations as they apply to
denied entities and potential transfers of technical data (deemed exports). All personal information provided will be controlled and protected in
accordance with the Data Protection Act 1998.

Date(s) of Visit:                                       to

Plant(s) to Visit:                 NEL           NTEL

                                                             PERSONAL INFORMATION

Full Legal Name
(Last, First, Middle):
Place of Birth           (List                                                      Citizenship(s) {List
Country):                                                                           Country(ies}:
Home Address: (Street Address – No PO Box,
City, County/State, Postal/Zip Code, Country)

                                                             CORPORATE INFORMATION

(Company Name):
Company Address (Street Address – No PO
Box, City, County/State, Postal/Zip Code, Country):
Parent Company
(Company Name):
Parent Company Address (Street
Address – No PO Box, City, County/State, Postal/Zip
Code, Country):

Is your company incorporated in the United States?                                      YES         NO

If answer is NO: In which country is your company incorporated?

Attach copy of valid government issued photo I.D. Valid photo I.D. (e.g., Drivers License/Passport) will be requested at the
Reception area upon your arrival, please ensure you bring relevant proof of ID with you. (All documents provided will be shredded
immediately after processing by an authorized NORDAM compliance representative.)

Visitor listed above must read the following and sign below (return completed form to NORDAM Compliance Department for
processing Visitor Badge Request:

              In consideration of my admission to NORDAM’s facility, I agree:
                   1. To maintain in confidence any information disclosed to me in writing, orally or by my observation during my visit (“Information”),
                        except information that I can show is readily available from public sources;
                   2. To use, reproduce and/or disclose Information, in whole or in part, solely for purposes previously approved by NORDAM in a
                        separate writing, and under no circumstances to use, reproduce and/or disclose Information, in whole or in part, for any purpose
                        that does not benefit NORDAM directly;
                   3. Upon request to return to NORDAM all Information (including copies of Information and all information derived from the
                        Information), and
                   4. Not to export, re-export or transship any Information except in accordance with the International Traffic in Arms Regulations
                        (“ITAR”). 22 C.F.R. Part 120 et seq., the Export Administration Regulations (“EAR”), 15 C.F.R. Part 730 et seq., or any other
                        export control laws or regulations of the United States or of any other country , as applicable.
                   5. I consent to NORDAM processing the data provided above for the sole purpose of complying with UK, US, EU, and Singapore
                        Compliance Rules and Regulations, as applicable.

Print name and title:                                                               Signature:                                      Date:

 NEL has a safe working policy and therefore requests that all visitors wear approved safety footwear during their visit. Dustcoats
 and safety glasses will be available on arrival. Your adherence to this policy is appreciated.

                                                                                                             Rev. 01/05/2008

Shared By: