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Use (1) to request road clearance and movement authority for the movement of outsized or overweight vehicles or (2) for the movement of convoys over a controlled or restricted road network. Reference: FM 100-15, FM 71-100, and FM 701-58.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — REFERENCE__________________________________(Reference: Data to Identify Request Being Referenced)

LINE 4 — UNIT ________________________________________(Identifier or Designator of Component Unit or Agency Requesting Clearance on Making Move)

LINE 5 — PRIORITY____________________________________(Mission Priority Requested for Movement)

LINE 6 — CONVOY NAME______________________________(Designated Convoy Name, if Any)

LINE 7 — COUNT OF SERIALS___________________________(Count of Serials in Convoy)

LINE 8 — SERIAL TIME_________________________________(Convoy Serial Time Interval, In Minutes)

LINE 9 — COUNT OF MARCH GROUPS___________________(Count of March Groups in Convoy)

LINE 10 — MARCH GROUP TIME_________________________(Convoy March Group Interval, in Minutes)

LINE 11 — HAZARDOUS CARGO_________________________(Hazardous Cargo: YES or NO)

LINE 12 — START TIME ________________________________(Latest DTG and Time Zone Lead Vehicle is Planned to Pass Start Point)

LINE 13 — RATE OF MARCH_____________________________(Estimated Rate of March)

LINE 14 — START POINT________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Starting Point)

LINE 15 — START POC__________________________________(Name of Start Point of Contact at Requesting Unit)

LINE 16 — LOCATION__________________________________(Location of Start POC Using UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 17 — FREQUENCIES_______________________________(Start POC’s Primary and Secondary Frequencies)

LINE 18 — PHONE NUMBERS____________________________(Start POC’s Primary and Secondary Phone Numbers)

LINE 19 — ARRIVAL TIME ______________________________(Estimated Arrival DTG of Moving Unit)

LINE 20 — END POINT _________________________________(Location of Ending Point Using UTM Accurate to 100 Meters, Same as Line 16)

LINE 21 — END POC ___________________________________(Name of End Point of Contact at Requesting Unit)

LINE 22 — LOCATION__________________________________(Location of End POC Using UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 23 — FREQUENCIES_______________________________(End POC’s Primary and Secondary Frequencies)

LINE 24 — PHONE NUMBERS____________________________(End POC’s Primary and Secondary Phone Numbers)

LINE 25 — ROUTE______________________________________(Description of Route Desired by Requestor)

LINE 26 — VEHICLES___________________________________(Number and Type of Vehicles in Movement)

LINE 27 — LENGTH____________________________________(Length of All Outsized Vehicles, or Length of Longest Vehicle in Inches)

LINE 28 — WIDTH______________________________________(Width of All Outsized Vehicles or Width of Widest Vehicle in Inches)

LINE 29 — HEIGHT_____________________________________(Height of All Outsized Vehicles or Height of Highest Vehicle in Inches)

LINE 30 — WEIGHT ____________________________________(Weight of All Overweight Vehicles or Weight of Heaviest Vehicle)

LINE 31 — LOAD CLASS________________________________(Military Load Classification of Vehicles in Movement)

LINE 32 — HAZARDOUS CARGO DATA___________________(Hazardous Cargo Classification, Shipping Name, Description, and Amount of Cargo)

LINE 33 — TRAFFIC CONTROL POINTS __________________(Proposed Traffic Control Points for the Road Movement)

**Repeat lines 4 through 33 to request road clearance for more than one unit. Assign sequential line numbers to succeeding iterations; for example, first iteration 4 through 33; second iteration 4a through 33a; and third iteration 4b through 33b; and so on.

LINE 34 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report

LINE 35 — AUTHENTICATION___________________________(Report Authentication)

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