Form DTI-DES001 "Certificate of Data Destruction by External Entity/Company" - Delaware

What Is Form DTI-DES001?

This is a legal form that was released by the Delaware Department of Technology and Information - a government authority operating within Delaware. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 19, 2021;
  • The latest edition provided by the Delaware Department of Technology and Information;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DTI-DES001 by clicking the link below or browse more documents and templates provided by the Delaware Department of Technology and Information.

ADVERTISEMENT
ADVERTISEMENT

Download Form DTI-DES001 "Certificate of Data Destruction by External Entity/Company" - Delaware

Download PDF

Fill PDF online

Rate (4.7 / 5) 23 votes
DELAWARE DEPARTMENT OF TECHNOLOGY AND INFORMATION
CERTIFICATE OF DATA DESTRUCTION
By External Entity/Company
The information described below was destroyed in the normal course of business pursuant to State of Delaware
retention schedule and the following policies and contract(s):
The Delaware Information Security Policy, Disposal of Electronic Storage Media:
http://dti.delaware.gov/pdfs/pp/StateOfDelawareInformationSecurityPolicy.pdf
Data Classification Policy:
http://dti.delaware.gov/pdfs/pp/DataClassificationPolicy.pdf
Disposal of Electronic/Storage Media Policy:
http://dti.delaware.gov/pdfs/pp/DisposalOfElectronicEquipmentAndStorageMedia.pdf
Enter Contract Name and number here, along with a brief description:
<for example> XXX will destroy all data files at the conclusion of the project and send a certified letter to the DTI
Chief Security Officer indicating the date, time and confirmation of the destruction. Include with the Data
Destruction Certification Letter and this form and any documentation produced from the data destruction/data
wipe software such as a certificate or certification log.
Date of Destruction:
Authorized By:
Description of Information Disposed of/Destroyed:
Inclusive Dates Covered:
METHOD OF DESTRUCTION:
Burning
Overwriting
Pulping
Pulverizing
Reformatting
Shredding
Other:___________________________________________________________________________
Records Destroyed BY*:
If On Site, Witnessed By:
Department Manager:
*If records destroyed by outside firm, must confirm a contract exists.
Form: DTI – DES 001
Updated/Reviewed: January 19, 2021
DELAWARE DEPARTMENT OF TECHNOLOGY AND INFORMATION
CERTIFICATE OF DATA DESTRUCTION
By External Entity/Company
The information described below was destroyed in the normal course of business pursuant to State of Delaware
retention schedule and the following policies and contract(s):
The Delaware Information Security Policy, Disposal of Electronic Storage Media:
http://dti.delaware.gov/pdfs/pp/StateOfDelawareInformationSecurityPolicy.pdf
Data Classification Policy:
http://dti.delaware.gov/pdfs/pp/DataClassificationPolicy.pdf
Disposal of Electronic/Storage Media Policy:
http://dti.delaware.gov/pdfs/pp/DisposalOfElectronicEquipmentAndStorageMedia.pdf
Enter Contract Name and number here, along with a brief description:
<for example> XXX will destroy all data files at the conclusion of the project and send a certified letter to the DTI
Chief Security Officer indicating the date, time and confirmation of the destruction. Include with the Data
Destruction Certification Letter and this form and any documentation produced from the data destruction/data
wipe software such as a certificate or certification log.
Date of Destruction:
Authorized By:
Description of Information Disposed of/Destroyed:
Inclusive Dates Covered:
METHOD OF DESTRUCTION:
Burning
Overwriting
Pulping
Pulverizing
Reformatting
Shredding
Other:___________________________________________________________________________
Records Destroyed BY*:
If On Site, Witnessed By:
Department Manager:
*If records destroyed by outside firm, must confirm a contract exists.
Form: DTI – DES 001
Updated/Reviewed: January 19, 2021