Transcription of INSTRUCTIONS FOR NATO SECURITY CLEARANCE …
1 INSTRUCTIONS FOR NATO SECURITY CLEARANCE CERTIFICATE (NSCC) The following certificate f orm must be completed in full. F ailure to complete all of the fields will result i n the (NSCC) b eing rejected. GENERAL INSTRUCTIONS Section 1 (Top half of form) The informati on requested within the fields of the top tw o lines of the form can beverified using the Joint Personnel Adjudication System (JPAS). The field below t he In accordance with paragraph should st ate t he subject s NATO SECURITY CLEARANCE level (select from the bulleted items listed on t he form). Provide name of the NATO Agency to be visited and its address. Provide the date of issue, which is the date of the first day of the visit.
2 This should bethe same date cited on the RFV form. (see block 4, U-1201 form)Section 2 (B ottom half of f orm) The certificate expirati on date listed must be no lat er than the last day of the subject svisit. This should be the same date cited on the RFV fo rm. (see block 4, U-1201 form) The certificate is NOT va lid without t he signature of the company SECURITY officer orFacility SECURITY Officer. Be sure to include date of signature and phone number of company secur ity offi ceror Facility SECURITY Officer in the appropriate completion, fax certificate along with Request For Visit form to DCSA International at (571) 305-6010, ATTN: InternationalFOR OFFICIAL USE ONLY NATO SECURITY CLEARANCE Certificate fica tion is hereby given that:Visitor Full Name:Date of Birth: Place of Birth: (C ity) (State) (Country) Has been grante d a SECURITY CLEARANCE by the Government of.
3 U nited St ates of A merica In accordance with current NATO regulations, including the SECURITY Annex to C-M (64) 39 in the case of ATOMAL information, and is, therefore, declared suitable to be entrusted w ith information classified up to and including: (Select Visitor s NATO s ecurity CLEARANCE level from the list below) COSMIC TOP SECRET NATO SECRET NATO CONFIDENTIAL COSMIC TOP SECRET ATOMAL NATO SECRET ATOMAL NATO CONFIDENTIAL ATOMAL NATO Agency to be visited: Address: Date of Issue: (Date of the first day of visit) certificate will expire no later than:(Date of expiration is the last day of the visit) Signature of Company SECURITY Officer or Facility SECURITY Officer Date Telephone # ISSUED BY: (FOR DCSA USE ONLY) Official Government Stamp NAME: ADDRESS: Defense Counterintelligence and SECURITY AgencyIndustrial SECURITY DirectorateAttn: Chief, International 27130 Telegraph Road Quantico, VA 22134 FAX: EMAIL: OFFICIAL USE ONLY
