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STANDARDIZATION AGREEMENT 3381, ANNEX B, NATO STANDARD FORM FOR REQUEST, RECEIPT, AND RETURN OR INVOICE
FORMULAIRE STANDARD OTAN DE DEMANDE, DE RESTITUTION OU DE FACTURATION
(AE Reg 1-3)
A. Request/Demande
Return/Restitution
C. Invoice/Facture
1. Requisition no./N° de la demande
2. Support agreement
Accord de réglement
3. Means of transport: Aircraft/
vehicle/ship/Moyen de transport:
Aéronef/véhicule/navire
4. From (requesting party)/De (demandeur)
5. Nation
6. To (supporting party)/A (fournisseur)
7. Nation
8. Time and place of delivery requested
Lieu et date de livraison demandé
9. Receiving party/Destinataire
10a. Date
10b. Name, grade, signature/Nom, grade, signature
11.
No.
N°
12. NATO stock no.
N° de nomenclature
13. Description
14. Measure unit
Unités des mesure
15. Quantity requested
Quantité demandée
16. Other costs/Autres frais
17. Method of compensation
Mode de compensation
Cash/Paiement
comptant
Equal value exchange
Échange contre même valeur
Replacement-in-kind
Remplacement en nature
18. Agreed date of return
Date de restitution
19. Authorization by official of supporting party (name, grade, signature)
Authorisation du responsable officiel (nom, grade, signature)
B. Acknowledgement of receipt/Accusé de réception
20. Receipt accepted/Réception accusée
Place and date/Lieu et date
Name, grade, signature/Nom, grade, signature
21. Transportation/Transport
Free of charge/Gratuit
With charge/A titre onéreux
22. Invoicing authority/Service de facturation
23. Invoice no./N° de la facture
Date
24. Transaction code
(U.S. use only)
25. Transportation document no.
N° de bordereau d'envoi
26. Account no.
(U.S. use only)
27. Quantity delivered
Quantité fournie
28. Unit price
Prix unitaire
29. Total
30. Attachments and vouchers
Pièces justificatives
31. Total amount claimed/Total de la facture
32. Currency/Monnaie
33. Payable to/account no./for / Payable à/n° de compte/règlement de
34. I certify that the amount invoiced is exclusive of all taxes for which exemption has been granted under provisions of existing agreements and that the invoice is correct./Je certifie l’exactitude de la présente facture; son montant n’inclut aucune des taxes dont l’exemption est accordée en vertu d’accords en vigueur.
35. Name, grade, signature/Nom, grade, signature
INSTRUCTIONSSTANDARD NATO AGREEMENT FORM 3381 (STANAG)
Block
number:
1 Enter a control number (includes a two-digit country identification, calendar year and Julian date, and sequential number (for example, PL-07097-007)).
2 Enter the code for the applicable ACSA (for example, US-XX-01, USA-XXX-01).
3 Enter the type of aircraft, vehicle, or ship; registration or hull; and home station or port, if applicable.
4 Enter the name of the unit or organization requesting the support or receiving the LSSS. (Use an additional sheet of paper if required.)
5 Enter the name of or abbreviation for the country requesting the support.
6 Enter the name of the unit or organization providing the support or LSSS. (Use an additional sheet of paper if required.)
7 Enter the name of or abbreviation for the country providing support.
8 Enter the date and time of delivery and the building number or location of delivery.
9 Enter the name of the unit or organization requesting the support or receiving the LSSS. (In most cases, this is the same as block 4.)
10 Enter the name, grade, and unit or office of the delegated requesting official. The name and grade should be typed or printed very legibly. A signature and date must be entered.
11 Enter the number used to identify each line item of support listed.
12 Enter the national stock number, if applicable.
13 Enter a general description of each item requested.
14 Enter the appropriate unit of measure for the specified type of LSSS (for example, BX, EA, GAL, LTR).
15 Enter the quantity of the specified item based on the entered unit of measure.
16 Enter all additional costs (for example, packing fees, loading and unloading fees, transportation costs).
17 Mark the box for—
“Cash” if the receiving nation pays with cash on location or as payment to an invoice.
“Equal value exchange” if support will be exchanged within 12 months.
“Replacement-in-kind” if like support will be reciprocated within 12 months.
18 Enter the name, grade, title, and signature of the individual authorized by the supporting party to sign. The date will be noted in ink same time as signature.
19 This date should be for items leased or loaned as well as for equal value exchanges or replacement-in-kind transactions. Dates for equal value exchange and replacement-in-kind transactions may not exceed 12 months after the date of initial delivery.
20 Enter the name, grade, unit, and signature of the individual authorized to sign and acknowledge receipt by the nation receiving support.
21 Not applicable.
22-26 To be completed by the invoicing authority (for example, USAREUR (G8)).
27 Enter the actual quantity of services provided.
28 Enter the standard price of the nation providing the support. Reciprocal pricing under an ACSA requires that one nation charge the other nation the same rate it would charge someone from the same nation.
29 Enter the subtotal of block 15 (estimated) or block 27 (actual) multiplied by block 28 for each item number.
30 Clearly identify all enclosed supporting documentation.
31 Add all line items in column 29 and enter this amount.
32 Indicate the type of currency noted either in capital letters or with currency symbol. (When the United States provides support, U.S. dollars are always requested for cash reimbursement. The ACSA states that the country providing support may be reimbursed. The ACSA states that the country providing support may be reimbursed in its currency.)
33-35 To be completed by the invoicing authority (for example, USAREUR (G8)).
9.0.0.2.20120627.2.874785
AE Form 1-3A, 30 October 2013 (LCD Vers. 01.00)
Standardization Agreement 3381, Annex B, NATO Standard Form for Request, Receipt, and Return or Invoice/Formulaire Standard Otan de Demande, de Restitution ou de Facturation
USAREUR G8 (AEAGF-IA, DSN 337-3818)
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1
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Click to print this form.: Click to send form (PDF file) by e-mail.: Click to reset/clear form. Digitally signed forms cannot be cleared.: JavaScript_Note_FIELD: Page_GoTo_FIELD: GotopageClick to go to page 1.: Click to go to page 2.: Form_NumberDate_FIELD: AE FORM 1-3A, OCT 13Form_Version_FIELD: LCD Vers. 01.00CurrentPage_FIELD: PageCount_FIELD: Enter requisition number.: Identify support agreement.: Enter type of transportation (aircraft, vehicle, or ship), registration/hull, and home station/port.: Enter requesting party.: Enter nation.: Enter supporting party.: Enter nation.: Enter time and place of delivery.: Enter receiving party.: Select from calendar or enter date of signature (YYYYMMDD).: Enter name and grade.: Enter your common access card (CAC) and click to digitally sign this form.: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter number.: Enter NATO stock number.: Enter description.: Enter unit of measure.: Enter quantity requested (digits only).: Enter additional costs (for example, transportation, packing, fees, customs).: Method of Compensation:Check for "Cash" (unchecked by default).: 0Method of Compensation:Check for "Equal value exchange" (unchecked by default).: 0Method of Compensation:Check for "Replacement-in-kind" (unchecked by default).: 0Select from calendar or enter agreed date of return (YYYYMMDD).: Enter name and grade of official of supporting party.: Enter your common access card (CAC) and click to digitally sign this form.: Enter place of signature.: Enter name and grade of person signing this part of the form.: Select from calendar or enter date of signature (YYYYMMDD).: Enter your common access card (CAC) and click to digitally sign this form.: Transportation:Check if transportation is free of charge (unchecked by default).: 0Transportation:Check if transportation is with charge (unchecked by default).: 0To be completed by the invoicing authority:Enter invoicing authority.: To be completed by the invoicing authority:Enter invoice number.: To be completed by the invoicing authority:Select from calendar or enter date (YYYYMMDD).: To be completed by the invoicing authority:Enter transaction code (U.S. use only).: To be completed by the invoicing authority:Enter transportation document number.: To be completed by the invoicing authority:Enter account number (U.S. use only).: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Enter quantity delivered (digits only).: Enter unit price (digits only).: Calculated field, no user interaction required (digits only).: 0.00000000Enter attachments and vouchers.: Calculated field, no user interaction required (digits only).: 0.00000000Enter the total amount claimed (digits only).: Enter currency (usually the currency of the supporting party).: To be completed by the invoicing authority:Enter payable to/account number/for.: To be completed by the invoicing authority:Enter name and grade of person signing this part of the form.: Enter your common access card (CAC) and click to digitally sign this form.: