NATO UNCLASSIFIED/ RELEASABLE TO INTERNET - PERSONAL IN CONFIDENCE (WHEN COMPLETED) TO BE COMPLETED ELECTRONICALLY

In-processing form (SF94 - 03 SEP 2018) is also available for download, at: https://www.shape2day.com/arrivingleaving/inprocessing SF 94 - AUG 18 ANNEX D SD 040-009

SHAPE ID CARD APPLICATION All personnel must be in possession a valid National Passport/Military ID Card when applying for a SHAPE ID Card

Part 1 Personal Details (applicable to all)

Name (Surname first) Marital Status (2)

Maiden Name Date of Marriage

Rank/Title Place of Marriage

Gender Service (3)

Country of Birth & Town Type of Member (4)

Nationality (1) Date of arrival in Belgium

Date of Birth Date of departure:

State of Birth (US and Canada only) NATO Rank

Part 2 Employment Details (not applicable for dependents)

Authorized post number (PE) Branch

Posting Start Date Bldg.

Posting End Date Rm.

Division Tel. Ext

Part 3 For dependents only (tick as appropriate) - please attach supporting notes/official documentation*

Name of the holder (titulaire) SHAPE ID CARD Nr./Post Number

Relationship with the holder (titulaire) Spouse Son Daughter *Civil Partnership *Cohabitation *Other

Part 4 Other details: complete where applicable

Have you been registered in Belgium Yes No From: To:

Do you hold any valid Belgium Id Yes No From: To:

Do you intend to reside in Belgium? If “yes” please indicate your current or future address. If “no”, leave the box blank.

Yes City/post code/name street Nr.

No

Last address abroad City/post code/name street Nr.

Tel. number/and GSM

Email address (official/personal)

Part 5 Situation related to vehicles imported in Belgium where applicable.

How many vehicles will you bring into Belgium and plate number Nr. Plate Nr: Plate Nr:

Part 6 SHAPE Language Testing Centre, Linguistic Services (Bldg 101, Room M104/105) For Military Personnel Assigned to an ACO PE Post

Language test

Yes - No

Presented him/herself with a valid English language proficiency certificate OR signed up for an English language proficiency test

Date: Stamp & Signature, SLTC

Applicant’s declaration ANY FALSE DECLARATION MAY RESULT IN THE LOSS OF SHAPE PRIVILEGES AND/OR IMMUNITIES. I UNDERSTAND THAT SHOULD ANY SUBSEQUENT INFORMATION ASCERTAINED BY SHAPE OR HOST NATION OFFICIALS REVEAL THAT I AM NOT ENTITLED TO RECEIVE SHAPE PRIVILEGES AND/OR ENTITLEMENTS, SUCH PRIVILEGES AND/OR ENTITLEMENTS CAN BE WITHDRAWN AND BELGIAN AUTHORITIES ARE EMPOWERED TO DEMAND REIMBURSEMENT OF APPLICABLE TAXES.

Applicant’s signature

Certified by Stamp/Date/Signature (NMRs/SU/J1 CHRM/SHAPE NCIA/ACTSEE)

(stamp of entitled authority) See SD 040-009

Determination Individual’s Legal Status and Classification

SHAPE BSG - FSCEP - REGISTRATION

SECTION (BLDG 210 - RM.110) TO BE COMPLETED BY BSG/FSCEP/RGN Personnel ONLY

Type of Member

Type of Card Stamp/Date/Signature

Matrix Status & Entitlements. APMS - Nr.

Remarks:

Nr. (to be numbered in order to permit a MIN FIN verification). BEL SID - Mod P or S. Request Nr. (if applicable):

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NATO UNCLASSIFIED/RELEASABLE TO INTERNET - PERSONAL IN CONFIDENCE (WHEN COMPLETED)

TO BE COMPLETED ELECTRONICALLY

SF94 – AUG 18

ANNEX D of SD 040-009

1. NATIONALITY

NATO

MEMBERS ALB ALBANIA BEL BELGIUM BGR BULGARIA CAN CANADA

HRV CROATIA CZE CZECH REPUBLIC DNK DENMARK EST ESTONIA

FRA FRANCE DEU GERMANY GRC GREECE HUN HUNGARY

ISL ICELAND ITA ITALY LVA LATVIA LTU LITHUANIA

LUX LUXEMBOURG MNE MONTENEGRO NLD NETHERLANDS NOR NORWAY

POL POLAND PRT PORTUGAL ROU ROMANIA SVK SLOVAKIA

SVN SLOVENIA ESP SPAIN TUR TURKEY GBR UNITED KINGDOM

USA UNITED STATES

PFP

MEMBERS* ARM ARMENIA AUT AUSTRIA AZE AZERBAIJAN BLR BELARUS

BIH BOSNIA AND HERZEGOVINA FIN FINLAND FYR FYROM GEO GEORGIA

IRE IRELAND KAZ KAZAKHSTAN KGZ KYRGYSTAN MLT MALTA

MDA MOLDOVA RUS RUSSIA SRB SERBIA SWE SWEDEN

CHE SWITZERLAND TJK TAJIKISTAN TKM TURKMENISTAN UKR UKRAINE

UZB UZBEKISTAN

MEDITERRANEAN

DIALOGUE

DZA ALGERIA EGY EGYPT ISR ISRAEL JOR JORDAN

MRT MAURITANIA MAR MOROCCO TUN TUNISIA

ICI* BHR BAHRAIN KWT KUWAIT QAT QATAR ARE UNITED ARAB EMIRATES

PATG* AFG AFGHANISTAN AUS AUSTRALIA COL COLOMBIA IRQ IRAQ

MNG MONGOLIA NZL NEW ZEALAND JPN JAPAN PAK PAKISTAN

PRK REPUBLIC OF KOREA

2. MARITAL STATUS

A MARRIED B CIVIL PARTNERSHIP C SINGLE D DIVORCED

E WIDOW(ER)

3. SERVICE

A ARMY AF AIR FORCE C CIVILIAN N NAVY

M MARINES

4. TYPE OF MEMBER

MIL MILITARY NIC NATO CIVILIAN CIV COMP NATIONAL CIVILIAN COMPONENT DEP DEPENDENT

CON CONSULTANT INT INTERNSHIP CCS CONCESSIONAIRES SAT SATELLITE

SFP FEDERAL POLICE LWF LOCAL WORK FORCE LWR LOCAL WAGE RATE LWS LOCAL WAGE SCALE

DIP DIPLOMAT PFP PARTNERSHIP FOR

PEACE

SIS SHAPE INTERNATIONAL SCHOOL CTR IHP US CONTRACTOR INDIRECT HIRE

TDY TEMP NATO DUTY (TRAVEL

ORDER IS REQUIRED)

OTH OTHERS CIV VOL CIVILIAN VOLUNTEER

PfP: Partnership for Peace

ICI: Istanbul Cooperation Initiative

PatG: Partners across the Globe

The SHAPE Visitors’ Office is located in Bldg 108 [Berlin Gate] and there a clerk will issue a one day access pass / vehicle pass (for the in-processing).

FSCEP - Registration Section (RGN), is located in Bldg 210 - Room 110. Opening hours: Monday to Thursday: 08.45 hrs to 13.00 hrs / 14.00 hrs to 17.00 hrs, Friday: 08.45 hrs to 13.00 hrs.

This request does not give access to Class II areas. Therefore, a validated SF 1, AF 107 and a Security Clearance are mandatory.

AMENDMENTS/COMMENTS

Users of this form are invited to send amendments/comments and suggested improvements to SHAPE J1-MOR - SHAPE Bldg.101

In-processing form (SF94 – 03 SEP 2018) is also available for download, at: http://www.shape2day.com/arriving--leaving-shape/inprocessing.aspx

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CTR CONTRACTOR