Records Destruction Certification Form
Please complete this form to certify the destruction of records in accordance with organizational policies and legal requirements.
Responsible Person's Full Name
*
First Name
Last Name
Organization or Department Name
*
Contact Email Address
*
example@example.com
Date of Destruction
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Description of Records Destroyed (e.g., type, quantity, date range)
*
Method of Destruction
*
Please Select
Shredding
Burning
Pulping
Degaussing
Other
Signature of Responsible Person
*
Submit Certification
Submit Certification
Should be Empty: