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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)
1
1
2
2
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.:
