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Diplomacy in Action

Instructions for Airport Escort Screening Courtesies (AESC) Request Form


Following are step-by-step instructions to fill out the Form DS-4138, Request for Escort Screening Courtesies .

Once completed please print, scan, and email Form DS-4138 to escortscreening@state.gov

1. Date of Request (The form contains drop-down boxes for the month, day, and year)

The date the request is submitted to the Office of Foreign Missions.

2. Passport Nationality

The issuing country on the traveler’s passport.

3. Passport Number

The passport number of the traveler’s passport.

4. Full Name of Traveler

The full name of the traveler as shown on the passport with the surname or family name in capital letters. (example: John SMITH)

5. Official Title

The official title of the traveler requesting Airport Escort Screening Courtesies.

6. Date of Birth

The date of birth of the traveler. (example: January 30, 1965)

7. Country of Birth

The traveler’s country of birth.

8. City of Birth

The name of the city in which the traveler was born.

9. Point of Contact

The Point-of-Contact (POC) should be someone who is available to receive calls during business and non-business hours from the assigned escort officer.

10. Organization

The POC’s organization (embassy, mission, etc.).

11. Telephone and Fax Numbers

The POC’s business hour telephone and fax numbers.

12. After Hours Telephone Number (s)

The POC’s after-hours phone number(s).

13. E-Mail Address for Confirmation

The e-mail address where the confirmation and future communications may be sent.

14. Airline and Flight No.

The traveler’s airline and flight number (example: Delta Airlines – DL 498).

15. Departure Airport

The airport the traveler is leaving.

16. Arrival Airport

The airport destination of the traveler.

17. Month/Day/Year (This form contains drop down boxes for the month, day, and year)

The departure and arrival dates.

18. Time

The departure and arrival flight times: Hour: Minute (example 08:23) and check AM or PM.

19. Itinerary Continues on Next Page

Check yes or no.

(content revision date 03/12/2013)


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