Approved For Release 2000/08/07 CIA-RDP96-00788ROO1200280032-5 D A T E GRILL FLAME, SECURITY AGREEMENT 1, -z- -, -understand that the highly sensitive and classified information I have, or a,#4-4 about to receive as part of the cTrinL FLAME Program belongs to the United States Government. I understand that 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. I understand that no change in my assignment or employment will relieve me, of my obligation under this agreement and that the provisions of this agreement will remain binding upon me even after the termination of my services with th,~- United States Goirerxzqent. 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: Na-tional Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering System for Federal Accounts Relating to Individual Persons, November 22, 1911'D. 2. PrincJ.pal Purpose: To maintain a record of those individuals who have or have had access to GRILL FLAME information through. the use of their name and./or Social Security Number. 3. Routine T TseE~: The Social. Security Number is to be used to identify the individual, and the information if, to be retained strictly within the ProgrqTn. 4. Mandatory or Volnn-I'lary 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 For Release 2000/08/07 : CIA-RDP96-00788ROO1200280032-5 Approved For Release 2000/08107 : CIA-RDP96-00788ROO1200280032-5 GRILL 'P'EE S . ME S,'CURITY AGREEMENT CONTINUATION PAGE DATE At SI ED: k(i gRA", 7'~ A4,9j- ~a NAME, RANK/GRADE NAME,,~7RANK/GRADE A lw-Ws -14,) mw T UNIT/ORGANIZATION L -N S e-z -t 691ct FLA-mp- Px')Je-~ &wPccr-- POSITION ~~O/ 1&,S(2 6)"1 UNP/ORGANIZATION PM~ITION Approved For Release 2000/08/07 : CIA-RDP96-00788ROO1200280032-5