# Commission Decision (EU, Euratom) 2019/1963 of 17 October 2019 laying down implementing rules on industrial security with regard to classified procurement contracts, Appendix C

Extent: E+W+S+N.I.

REQUEST FOR VISIT
(MODEL)
Detailed instructions for completion of request for visit
(The application must be submitted in English only)
HEADING
Check boxes for visit type, information type, and indicate how many sites are to be visited and the number of visitors.
4.
ADMINISTRATIVE DATA
To be completed by requesting NSA/DSA.
5.
REQUESTING ORGANISATION OR INDUSTRIAL FACILITY
Give full name and postal address.
Include city, state and post code as applicable.
6.
ORGANISATION OR INDUSTRIAL FACILITY TO BE VISITED
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:
(1) Giving the correct post code (zip code) is important because a company may have various different facilities.
(2) When applying manually, Annex 1 can be used when two or more facilities have to be visited in connection with the same subject. When an Annex is used, item 3 should state: ‘SEE ANNEX 1, NUMBER OF FAC: …’ (state number of facilities).
7.
DATES OF VISIT
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.
8.
TYPE OF INITIATIVE
Specify whether the visit has been initiated by the requesting organisation or facility or by invitation of the facility to be visited.
9.
THE VISIT RELATES TO:
Specify the full name of the project, contract or call for tender using commonly used abbreviations only.
10.
SUBJECT TO BE DISCUSSED/JUSTIFICATION
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_____)
11.
ANTICIPATED LEVEL OF CLASSIFIED INFORMATION TO BE INVOLVED
State SECRET UE/EU SECRET (S-UE/EU-S)
or
CONFIDENTIEL UE/EU CONFIDENTIAL (C-UE/EU-C), as appropriate.
12.
PARTICULARS OF VISITOR
Remark: when more than two visitors are involved in the visit, Annex 2 should be used.
13.
THE SECURITY OFFICER OF THE REQUESTING ENTITY
This item requires the name, telephone number, fax number and email of the requesting facility’s Security Officer.
14.
CERTIFICATION OF SECURITY CLEARANCE
This field is to be completed by the certifying authority.
Notes for the certifying authority:
(a) Give name, address, telephone number, fax number and email (can be pre-printed).
(b) This item should be signed and stamped (if applicable).
15.
REQUESTING SECURITY AUTHORITY
This field is to be completed by the NSA/DSA.
Note for the NSA/DSA:
(a) Give name, address, telephone number, fax number and email (can be pre-printed).
(b) This item should be signed and stamped (if applicable).
All fields must be completed and the form submitted via Government-to-Government channels
REQUEST FOR VISIT
(MODEL)
To: _______________________________________
1.
TYPE OF VISIT REQUEST
2.
TYPE OF INFORMATION
3.
SUMMARY
☐ Single
☐ Recurring
☐ Emergency
☐ Amendment
☐ Dates
☐ Visitors
☐ Facility
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: _____
4.
ADMINISTRATIVE DATA:
Requester:
To:
NSA/DSA RFV Reference No________________
Date (dd/mm/yyyy): _____/_____/_____
5.
REQUESTING ORGANISATION OR INDUSTRIAL FACILITY:
NAME:
POSTAL ADDRESS:
E-MAIL ADDRESS:
FAX NO:
TELEPHONE NO:
6.
ORGANISATION(S) OR INDUSTRIAL FACILITY(IES) TO BE VISITED (Annex 1 to be completed)
7.
DATE OF VISIT (dd/mm/yyyy): FROM _____/_____/_____ TO _____/_____/_____
8.
TYPE OF INITIATIVE:
☐ Initiated by requesting organisation or facility
☐ By invitation of the facility to be visited
9.
THE VISIT RELATES TO CONTRACT:
10.
SUBJECT TO BE DISCUSSED/REASONS/PURPOSE (Include details of host entity and any other relevant information. Abbreviations should be avoided):
11.
ANTICIPATED HIGHEST CLASSIFICATION LEVEL OF INFORMATION/MATERIAL OR SITE ACCESS TO BE INVOLVED:
12.
PARTICULARS OF VISITOR(S) (Annex 2 to be completed)
13.
THE SECURITY OFFICER OF THE REQUESTING ORGANISATION OR INDUSTRIAL FACILITY:
NAME:
TELEPHONE NO:
E-MAIL ADDRESS:
SIGNATURE:
14.
CERTIFICATION OF SECURITY CLEARANCE LEVEL:
NAME:
ADDRESS:
TELEPHONE NO:
E-MAIL ADDRESS:
SIGNATURE:
DATE (dd/mm/yyyy): _____/_____/_____
15.
REQUESTING NATIONAL SECURITY AUTHORITY/DESIGNATED SECURITY AUTHORITY:
NAME:
ADDRESS:
TELEPHONE NO:
E-MAIL ADDRESS:
SIGNATURE:
DATE (dd/mm/yyyy): _____/_____/_____
16.
REMARKS (Mandatory justification required in the case of an emergency visit):
<Placeholder for reference to applicable personal data legislation and link to mandatory information to the data subject, e.g. how Article 13 of the General Data Protection Regulation is implemented.>

---
Source: https://www.legislation.gov.uk/eudn/2019/1963/annex/III/appendix/C (the official version)
Page: https://openlegislation.uk/eu-decision-2019-1963/annex-III/appendix-C
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.