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Use to request rear area security assistance. Reference: FM 100-15, FM 71-100, and FM 19-1.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — REQUESTER__________________________________(Identifier of Unit/Agency Requesting Security Assistance)

LINE 4 — SECURITY ACTIVITY__________________________(Security Activity Being Requested)

LINE 5 — UNITS_______________________________________(Number and Type Units Required to Conduct the Mission; if Unknown, State UNKNOWN)

LINE 6 — DATE AND TIME______________________________(Date and Time Assistance is Required)

LINE 7 — DURATION___________________________________(Estimated Duration Time of the Mission in Hours)

LINE 8 — LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator Where Security Assistance Mission Will be Conducted)

LINE 9 — INITIAL POINT________________________________(Initial or Start Point Location Using UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 10 — TRACE PLOT________________________________(Trace Plot Defined by a Series of Points in Sequence UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 11 — CALL SIGN__________________________________(Call Sign of Unit Requesting the Security Activity)

LINE 12 — PRIMARY___________________________________(Primary Radio Frequency of Unit Requesting the Security Activity)

LINE 13 — SECONDARY________________________________(Secondary Radio Frequency of Unit Requesting the Security Activity)

LINE 14 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

**Repeat lines 3 through 14 to identify multiple requests for security assistance. Assign sequential line numbers to succeeding iterations; for example, first iteration 3 through 14; second iteration 3a through 14a; third iteration, 3b through 14b; and so on.

LINE 15 — AUTHENTICATION___________________________(Report Authentication)

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