The performance of the contract is subject to particular conditions

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The performance of the contract is subject to particular conditions

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HEADING

Check boxes for visit type, information type, and indicate how many sites are to be visited and the number of visitors.

To be completed by requesting NSA/DSA.

Give full name and postal address.

Include city, state and post code as applicable.

Give full name and postal address. Include city, state, post code, telex or fax number (if applicable), telephone number and email. Give the name and telephone/fax numbers and email of your main point of contact or the person with whom you have made the appointment for the visit.

Remarks:

Give the actual date or period (date-to-date) of the visit in the format ‘day — month — year’. Where applicable, give an alternate date or period in brackets.

Specify whether the visit has been initiated by the requesting organisation or facility or by invitation of the facility to be visited.

Specify the full name of the project, contract or call for tender using commonly used abbreviations only.

Give a brief description of the reason(s) for the visit. Do not use unexplained abbreviations.

Remarks:

In the case of recurring visits this item should state ‘Recurring visits’ as the first words in the data element (e.g. Recurring visits to discuss_____)

State SECRET UE/EU SECRET (S-UE/EU-S)

or

CONFIDENTIEL UE/EU CONFIDENTIAL (C-UE/EU-C), as appropriate.

Remark: when more than two visitors are involved in the visit, Annex 2 should be used.

This item requires the name, telephone number, fax number and email of the requesting facility’s Security Officer.

This field is to be completed by the certifying authority.

Notes for the certifying authority:

This field is to be completed by the NSA/DSA.

Note for the NSA/DSA:

REQUEST FOR VISIT

(MODEL)

To: _______________________________________

☐ Single

☐ Recurring

☐ Emergency

☐ Amendment

For an amendment, insert the NSA/DSA original RFV Reference No_____________

☐ C-UE/EU-C

☐ S-UE/EU-S

No of sites: _______

No of visitors: _____

Requester:

To:

NSA/DSA RFV Reference No________________

Date (dd/mm/yyyy): _____/_____/_____

NAME:

POSTAL ADDRESS:

E-MAIL ADDRESS:

FAX NO:

TELEPHONE NO:

☐ Initiated by requesting organisation or facility

☐ By invitation of the facility to be visited

NAME:

TELEPHONE NO:

E-MAIL ADDRESS:

SIGNATURE:

NAME:

ADDRESS:

TELEPHONE NO:

E-MAIL ADDRESS:

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SIGNATURE:

DATE (dd/mm/yyyy): _____/_____/_____

NAME:

ADDRESS:

TELEPHONE NO:

E-MAIL ADDRESS:

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SIGNATURE:

DATE (dd/mm/yyyy): _____/_____/_____

ORGANISATION(S) OR INDUSTRIAL FACILITY(IES) TO BE VISITED

1.

NAME:

ADDRESS:

TELEPHONE NO:

FAX NO:

NAME OF POINT OF CONTACT:

E-MAIL:

TELEPHONE NO:

NAME OF SECURITY OFFICER OR

SECONDARY POINT OF CONTACT:

E-MAIL:

TELEPHONE NO:

2.

NAME:

ADDRESS:

TELEPHONE NO:

FAX NO:

NAME OF POINT OF CONTACT:

E-MAIL:

TELEPHONE NO:

NAME OF SECURITY OFFICER OR

SECONDARY POINT OF CONTACT:

E-MAIL:

TELEPHONE NO:

(Continue as required)

PARTICULARS OF VISITOR(S)

1.

SURNAME:

FIRST NAMES (as per passport):

DATE OF BIRTH (dd/mm/yyyy): ____/____/____

PLACE OF BIRTH:

NATIONALITY:

SECURITY CLEARANCE LEVEL:

PP/ID NUMBER:

POSITION:

COMPANY/ORGANISATION:

2.

SURNAME:

FIRST NAMES (as per passport):

DATE OF BIRTH (dd/mm/yyyy): ____/____/____

PLACE OF BIRTH:

NATIONALITY:

SECURITY CLEARANCE LEVEL:

PP/ID NUMBER:

POSITION:

COMPANY/ORGANISATION:

(Continue as required)

HEADER

The requester inserts full NSA/DSA and country name.

The requesting contracting authority selects the appropriate checkbox for the type of FSCIS request. Include the level of security clearance requested. The following abbreviations should be used:

SECRET UE/EU SECRET = S-UE/EU-S

CONFIDENTIEL UE/EU CONFIDENTIAL = C-UE/EU-C

CIS = Communication and information systems for processing classified information

Fields 1 to 6 are self-evident.

In field 4 the standard two-letter country code should be used. Field 5 is optional.

Give the specific reason for the request, provide project indicators, number of contract or invitation to tender. Please specify the need for storage capability, CIS classification level, etc.

Any deadline/expiry/award dates which may have a bearing on the completion of an FSC should be included.

State the name of the actual requester (on behalf of the NSA/DSA) and the date of the request in number format (dd/mm/yyyy).

Fields 1-5: select appropriate fields.

Field 2: if an FSC is in progress, it is recommended to give the requester an indication of the required processing time (if known).

Field 6:

May be used for additional information with regard to the FSC, the facility or the foregoing items.

State the name of the providing authority (on behalf of the NSA/DSA) and the date of the reply in number format (dd/mm/yyyy).

REQUEST FOR A FACILITY SECURITY CLEARANCE ASSURANCE

To: ____________________________________

(NSA/DSA Country name)

Please complete the reply boxes, where applicable:

[ ] Provide an FSC assurance at the level of: [ ] S-UE/EU-S [ ] C-UE/EU-C

for the facility listed below

[ ] Initiate, directly or upon a corresponding request of a contractor or subcontractor, the process of obtaining an FSC up to and including the level of … with … level of safeguarding and … level of CIS, if the facility does not currently hold these levels of capabilities.

Confirm accuracy of the details of the facility listed below and provide corrections/additions as required.

Corrections/Additions:

…

…

…

…

…

…

…

…

…

…

…

…

…

Requesting NSA/DSA/Commission contracting authority: Name: … Date: (dd/mm/yyyy) …

REPLY (within ten working days)

This is to certify that:

Member State

FSC

Notification of contract or subcontract involving R-UE/EU-R information to NSA/DSA

PSC

YES

NO

YES

NO

YES

NO

Belgium

X

X

X

Bulgaria

X

X

X

Czechia

X

X

X

Denmark

X

X

X

Germany

X

X

X

Estonia

X

X

X

Ireland

X

X

X

Greece

X

X

X

Spain

X

X

X

France

X

X

X

Croatia

X

X

X

Italy

X

X

X

Cyprus

X

X

X

Latvia

X

X

X

Lithuania

X

X

X

Luxembourg

X

X

X

Hungary

X

X

X

Malta

X

X

X

Netherlands

X

(for defence-related contracts only)

X

(for defence-related contracts only)

X

Austria

X

X

X

Poland

X

X

X

Portugal

X

X

X

Romania

X

X

X

Slovenia

X

X

X

Slovakia

X

X

X

Finland

X

X

X

Sweden

X

(for defence-related contracts only)

X

(for defence-related contracts only)

X

(for defence-related contracts only)

United Kingdom

X

X

X