Approved For Release 2003/09MO: CIA-RDP96-0078BROO120102807
DATE I @
GRILL FLAME SECURITY AGREEMENT
SG11 - - 1 understand that the highly
SenSltlVe and ciassiried inTormation I have, or are about to
receive as part of the GRILL FLAME Program belongs to the
United States Government. I understand that the disclosure
of this information is punishable under Title 18, Section
798,-U.S.C., "Disclosure of Classified information," June 1948,
as amended.
I do solemnly swear that I will never divulge, publish, -or
reveal by word, conduct, or by any other means such classified
information or knowledge, except in the performance of my
official" duties, and as specifically authorized in writing
in each case by the appropriate agency'of the United,States
Government.
1@understand that no change in my assignment or emgloyment
will relieve me of my obligation under this agreement and
-that the provision's of this agreement will remain..binding
upon me even after the termination of my services with the
United States Government.
I'take this obligation of my own. free will, without any mental.
reservation or purpose of evasion.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
(5 U.S.C. 552a)
1. Authority: National Records Act, 44 U.S.C. 3102; E.O.
9397, Numbering System for Federal Accounts Relating to
individual Personsl, November 22, 1943.
2. Principal Purpose: To maintain a record of those individ-
uals who have or have had access to GRILL FLME information
through the use of their name and/or Social Security Number.
3. Routine Uses: The Social Security Number is to be used
to identify the individual, and the information is to be
retained strictly within the Program.
4. Mandatory or Voluntary Disclosure: Information is
disclosed on a voluntary basis, but withholding information
will render it impossible to grant an individual access to
or participation in the Program.
Approved Foe Release 2003109/10: CIA-RDP96-00788 ROO 12002800067.4
Approved For Release 2003/09f 10 : CIA-RDP96-00788RO01 200280006-4
GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE
WITNESS:
NINE-# KA_NK -GRADE
SG1 I
-fAr A 0-4@fZ.
NS
V-PGANIZATION
6RG NTZATION UNbT 0
UNIFT77
POSITION POSITION
Approved For Release 2003/09/10 CIA@RDP96-00788ROO1200280006-4