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 Singaporelaws 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 Country):

/

Citizenship(s) {List Country(ies}:

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

corporateINFORMATION

Representing(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 withUK, US, EU, and SingaporeCompliance 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