RMA STATEMENT OF DESTROYED MATERIALS Rev.2.1
Certification of Destruction statement:
By signature below I certify that due to sensitive data resident on the Hard Disk Drive(s) (HDD) or Solid State Drive(s) (SSD) in
use by this agency. Disk drives may not be removed from this site. When a Disk drive requires replacement under warranty, this
Certificate of Destruction (COD) having all of the information inserted and signed by the designated personnel will serve, as
evidence of the complete destruction of the Disk drive and a replacement under warranty will be authorized.
I certify that the drive(s) listed below are defective and have been destroyed. We verify that all of the following apply:
1.
2.
3.
4.
The agency or contractor owns the drive(s)
The agency is unable to return the drive(s) due to classified information stored on the drive(s)
The drive(s) have failed for reasons that are covered under warranty
The failed drive(s) have been physically destroyed (crushed or otherwise)
Contact: ______________________________________________
Title: _________________________________________________
Phone: _______________________________________________
Email: _____________________________
Department: __________________________________________
Agency/ Company: _____________________________________
Signature: _____________________________________________
Manufacturer:
Drive Serial No.
Part No.
Date: ______________________________
Service Request No.
* Single form per manufacturer
* Maximum of 2 media items
NOTICE:
FOR SOLID STATE / COMPACT FLASH
TO ENSURE RECLIMATION, THIS FORM AND THE FOLLOWING MUST BE RETURNED TO THE EMAIL ADDRESS
BELOW:
1. PHOTOCOPY OR PICURE OF DRIVES LABEL INFORMATION
FOR MECHANICAL HARD DRIVES
TO ENSURE RECLIMATION, THIS FORM AND THE FOLLOWING MUST BE RETURNED TO THE PHYSICAL ADDRESS
BELOW:
1. THE TOP PLATE OF THE DEFECTIVE DRIVE (Containing label information)
2. THE BOTTOM PCB (Printed Circuit Board)
RETURN INFORMATION:
EMAIL:
[email protected]
MAIL ADDRESS: (For return of top plates and PCB)
ON PROCESS TECHNOLOGY: ICO (INTEL SECURITY)
ATTN: G. Bettencourt (Service Request Number)
200 Homer Avenue
Ashland, MA 01721
U.S.A.
Phone: (508) - 520 – 2771
For Intel Security use:
Vendor RMA#:
_____________________________________
Possible returns#: _____________________________________
ISN#:
_____________________________________
Intel Security * www.intelsecurity.com