Request for Non-Accessioned Disposal

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: