DATA AND RECORD DISPOSAL FORM

Department: Date:

Manager:
Method of
Disposal
Retention Retention Reason for
No. Data / Record Title Record No. (Shred, burn, Remarks
From Period Disposal
etc.)
1
2
3
Requested by Reviewed by Approved by

Sign

Name
Date
Data destroyed by: at:

Sign

MVEC-PR-003-F-04-RA Page 1 of 1