FKOBST 358-1 - Forsvarets Efterretningstjeneste

BILAG 3 til AFSNIT I til KAPITEL 8 FKOBST 358-1
2012-12
CERTIFICATE OF SECURITY CLEARANCE (AFSKRIFT)
CERTIFICATE OF SECURITY CLEARANCE
Issued by .........................................................................................................................................
(member nation or EU/WEU/NATO civil or military body)
Date and Place of Issue
.........................................................................................................................................................
.............................................. Valid until ......................................................................................
This is to certify that:
Full Name ........................................................................................................................................
Date of Birth .....................................................................................................................................
Place of Birth ...................................................................................................................................
Nationality ........................................................................................................................................
Where employed .............................................................................................................................
Purpose and Duration of Visit ..........................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
Holder of Passport/Identity Card No. ...............................................................................................
Issued at ....................................................................... Dated .....................................................
Military Rank and Number (where applicable) .................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
has been granted access to EU, WEU or NATO information classified up to and including
........................................................................................................................ in accordance with
current EU, WEU or NATO security regulations (NATO:including the Security Annex to C-M(64)39,
and has been briefed accordingly by
.........................................................................................................................................................
Signed:
Title: Official government stamp (Optional)
Date:
NOTE : This certificate must be handled in accordance with the provisions of
NATO
Security Policy and its supporting directives.
8-I-3-1