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RTO NATO MEMBERS SECURITY CLEARANCE CERTIFICATE (MSG) by pluggone

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									APPENDIX 2
TO ANNEX A

VCR FORMAT FOR NATO IN FRANCE
GENERAL          VISITORS ARE ONLY REQR TO COMPLETE THIS APPENDIX IF THEY VISIT
                 RTO/RTA (NATO IN FRANCE) AT NEUILLY-SUR-SEINE

             RTO NATO MEMBERS SECURITY CLEARANCE CERTIFICATE (MSG)

SUBMIT THROUGH: APPROPRIATE NATIONAL SECURITY CHANNELS

THIS IS TO CERTIFY THAT: (TYPE OR PRINT)

TITLE AND FULL NAME (FIRST, MIDDLE, LAST)
____________________________________________________________________________________

HAS BEEN CLEARED FOR ACCESS TO INFORMATION CLASSIFIED UP TO AND INCLUDING NATO
SECRET.

       ****(MANDATORY) VALID UNTIL/EXPIRES:___________________

DATE OF BIRTH (DDMMYY)_____________ PLACE OF BIRTH______________________________

NATIONALITY_________HOLDER OF PASSPORT NUMBER ________________________________

ISSUED AT __________________________ DATE OF ISSUE (DDMMYY)_______________________

BUSINESS ADDRESS
___________________________________________________________________________________
_____________________________________________________________________________________________
__________________________________________________________________________

CLASSIFIED MAILING ADDRESS
______________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________

TELEPHONE NUMBER _____________________________FAX NUMBER______________________

E-MAIL ADDRESS IF APPLICABLE______________________________________________________

***CERTIFIED BY AUTHORIZED NATIONAL SECURITY OFFICER:**

SIGNATURE _________________________________________________

NAME (TYPED OR PRINTED)________________________________________

TITLE_______________________________________________________

ORGANIZATION ADDRESS_____________________________________       OFFICIAL STAMP/SEAL

___________________________________________________________

____________________________________________________________

TELEPHONE NUMBER ________________________________________

************************************************************************************
  PLEASE RETURN THIS FORM DULY EXECUTED TO THE RTA DEPUTY SECURITY OFFICER
      (FROM EUROPE)                 (FROM USA ONLY)          (FROM ANYWHERE)
TO:   DEPUTY SECURITY OFFICER       RTA NATO              FAX: 33(0)1 5561 2299
      RTA/NATO                      ATTN: DEPUTY SECURITY OFFICER
      BP 25, 7 RUE ANCELLE          PSC 116
      F-92201 NEUILLY SUR SEINE CEDEX APO AE 09777
      FRANCE

								
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