Government Contract Destruction Certification Form
Use this form to document and certify the destruction of government contract records and related materials.
Contract Identification
Government Contract Number or Contract Reference
*
Contract Title / Project Name
*
Agency / Department Name
*
Destruction Certificate Number or Record ID
*
Destruction Details
Date of Destruction
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Description of Documents/Materials Destroyed
*
Quantity/Volume Destroyed
Certification and Sign-Off
Destruction Certification Statement
*
Acknowledgment of Accuracy
*
I confirm the information provided is accurate and complete.
Certifying Officer/Authorized Representative Name
*
First Name
Last Name
Job Title/Role
*
Submit
Should be Empty: