I certify that the above information is true and correct and that it is my responsibility to update general information where applicable. I understand that I must wear this grounds pass visibly while accessing the United Nations Headquarters premises in New York and to surrender my grounds pass when requested to do so by an officer of the Security and Safety Service. I understand that I will be required to surrender my grounds pass when I am separated from service or suspended from duty in the context of disciplinary proceedings. I also understand that this grounds pass is for the intended purpose of permitting access to the United Nations premises in New York and not for any other purpose. This grounds pass is non-transferable and misuse will result in its confiscation.
Signature of Applicant: __________________________________________________ Date: ______________________