Privacy Act Statement:

Section 6311 of Title 5, United States Code, authorizes collection of this information. PERSONAL DATA, TO BE TREATED IN CONFIDENTIAL MANNER. Use is RESTRICTED, To be secured when not in use.

NBVC BASE ACCESS APPLICATION
SECTION 1 - Sponsor Information

Last Name / First Name / Sponsorship Authority / Command / Work Phone / Home Phone / Type of Access
Select from Category:NBVC Govt. EmpDoD CivilianMilitary (Active Duty)Military (Retired)Military(Active Reserve)Military(RetiredReserve)Military (Dependent)National GuardSponsorship Authority Badge / NBVC / Select Access TypeNBVC BadgeNBVC Access List

SECTION 2 - Visit Information

Base / Visit Start Date / Visit End Date / Purpose of Visit
Select One BelowPoint MuguPort HuenemeSNIAll NBVC / Select one below:ContractorCommisary WorkerHR BusinessVendorVisitor - BardVisitor - MWR GolfVisitor - Resident HsgAgent AssistBusiness PartnerCare ProviderTaxi
Unescorted Destination or Event Location / Event or Activity Name-(Access List Only) / Access Gate - (Access List Only) / Time of Event - (Access List Only)
1169 FFSC / TAP / Select Access Gate:PH - SunkistPH - BardPH - Pleasant ValleyPH - VictoriaPM - MainPM - Las Posas

SECTION 3 – Contractor’s Company Information

Company Name / Company Address / Company Phone Number
Date of National Agency Check / Completed DHS-I9 Validated by Sponsor / Contract Expiration Date:
Yes

SECTION 4– Visitor / Contractor Information

Last Name / First Name / Middle Name / Last 4 SSN / Address / City/Zip Code / DOB / DL# / State / Citizenship
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card

Navy Sponsor Signature:______PID Staff Member Name: ______PID Staff Member Signature: ______

NOTE: Press F1 for instructions on how to complete each field on the application or click here to open instructions to complete NBVC Badge Application Form

SECTION 4 - Visitor / Contractor Information (continued)

Last Name / First Name / Middle Name / Last 4 SSN / Address / City/Zip Code / DOB / DL# / State / Citizenship
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card
Select OneUSANon USA w/Permanent Resident Card

Navy Sponsor Signature:______PID Staff Member Name: ______PID Staff Member Signature: ______

NOTE: Press F1 for instructions on how to complete each field on the application or click here to open instructions to complete NBVC Badge Application Form

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