Approved For Release 2001/04/02 : CIA-RDP96-0088RO01200010005-4
 DATE
 GRILL FLAME SECURITY AGREEMENT
 I" understand that the highly
 ns-itive and c as.W@Kwa Yo__- 'on I have, or are about to
   in ormati
 se n i
 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.
 I-,.understand that no change in my assignment or emgloyment
 w
      l
 ill 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 FLAME 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.
 W
 Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010005-4

Approved For Release 2001/04/02 CIA-RDP96-00788ROO1200010005-4
GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE
DATE 7L
WITNESS:, SIGNED:
='T
NAMEj RANK/GRADE NAMEt RANX/GRADE
ej@ -IT4
UNrT76AGANIZATION UiiIT/ORGANIZATION
I Y-O Ll I
POSITION POSITION V
2
Approved For Release 2001/04/02 CIA-RDP96-00788ROO1200010005-4