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Proactive Disclosure
Request for Non-Accessioned Disposal
Disclaimer: The HTML version of these forms is a representation of the content only. Please download the PDF version to use with your procurement. If you encounter problems or have questions regarding the PDF please contact Acquisitions.
Department:
Room no.:
Address:
Telephone:
It is requested that the following described records be destroyed by shredding at a Federal Records Centre Building or by other secure disposal means.
Type of records:
Security classification:
Incl. Years:
Extent (lin. Metres):
NA/TB Authority no.:
Authorized by (signature):
Date:
Print name:
Position:
Signature for receipt FRC:
Date:
Federal Record Centres
Certificate of destruction
This is to certify that the above described records have been destroyed by:
Witnessed by: (Signature)
Print name:
Date:
Certified by: (Signature)
Print name:
Date:
