Fillable Dd Form 2345 - Militarily Critical Technical Data Agreement printable pdf download

MILITARILY CRITICAL TECHNICAL DATA AGREEMENT

OMB No. 0704-0207

(Please read Agency Disclosure Notice and Instructions on back

OMB approval expires

before completing this form.)

Mar 31, 2019

MAIL THE ORIGINAL, COMPLETED FORM AND A COPY OF YOUR COMPANY'S INCORPORATION CERTIFICATE, STATE/ PROVINCIAL

BUSINESS LICENSE, SALES TAX IDENTIFICATION FORM OR OTHER DOCUMENTATION WHICH VERIFIES THE LEGITIMACY OF THE

COMPANY TO:

U.S./CANADA JOINT CERTIFICATION OFFICE

DLA LOGISTICS INFORMATION SERVICE

FEDERAL CENTER, 74 WASHINGTON AVE., NORTH

BATTLE CREEK, MI USA 49037-3084

1. TYPE OF SUBMISSION (X one)

a. INITIAL SUBMISSION

b. REVISION

c. 5-YEAR RENEWAL

2. ENTERPRISE OR INDIVIDUAL DATA (Referred to as a "certified contractor" upon acceptance of certification by the U.S./Canada - JCO)

a. NAME (Name of Enterprise or Individual)

b. ADDRESS (Physical address, including P.O. Box if applicable)

c. NAME OF SUBSIDIARY/DIVISION/DEPARTMENT

d. CAGE CODE (Mandatory for Enterprise)

3. DATA CUSTODIAN

a. NAME (See Instructions)

b. TELEPHONE NUMBER (Primary Company Number preferred - include area code)

c. TITLE

d. E-MAIL ADDRESS

4. DESCRIPTION OF RELEVANT BUSINESS ACTIVITY (Print or type)

5. AS A CONDITION OF RECEIVING MILITARILY CRITICAL TECHNICAL DATA, THE ENTERPRISE OR INDIVIDUAL CERTIFIES THAT:

a. CITIZENSHIP/RESIDENCY STATUS.

d. They will not provide access to militarily critical technical data to persons other

The individual designated by name in Item 3, who will act as custodian of the

than their employees or eligible persons designated by the registrant to act on their

militarily critical technical data on behalf of the contractor, is a citizen or person

behalf unless such access is permitted by U.S. DoDD 5230.25, Canada's TDCR, or

admitted lawfully for permanent residence into:

by the U.S. or Canadian Government agency that provided the technical data.

(X (1) or (2))

(1) THE UNITED STATES

(2) CANADA

e. No person employed by the enterprise or eligible persons designated by the

b. The data are needed to bid or perform on a contract with any agency of the U.S.

registrant to act on their behalf, who will have access to militarily critical technical

Government or the Canadian Government or for other legitimate business activities

data, is disbarred, suspended, or otherwise ineligible to perform on U.S. or

in which the contractor is engaged, or plans to engage.

Canadian Government contracts or has violated U.S. or contravened Canadian

export control laws or has had a certification revoked under the provisions of U.S.

c. They (1) acknowledge all responsibilities under applicable U.S. export control

DoDD 5230.25 or Canada's TDCR.

laws and regulations (including the obligation, under certain circumstances, to obtain

an export license from the U.S. Government prior to the release of militarily critical

technical data within the United States) or applicable Canadian export control laws

f. They are not themself debarred, suspended, or otherwise ineligible to perform on

and regulations, and (2) agree not to disseminate militarily critical technical data in a

U.S. or Canadian Government contracts, and have not violated U.S. or contravened

manner that would violate applicable U.S. or Canadian export control laws and

Canadian export control laws, and have not had a certification revoked under the

regulations.

provisions of U.S. DoDD 5230.25 or Canada's TDCR.

6. CONTRACTOR CERTIFICATION

I certify that the information and certifications made by me are true, complete, and accurate to the best of my knowledge and belief and are made

in good faith. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both.

(For U.S. contractors see U.S. Code, Title 18, Section 1001 and for Canadian contractors see the Defense Production Act.)

a. TYPED NAME (LAST, First, Middle Initial)

c. SIGNATURE (See Instructions)

b. TITLE

d. DATE SIGNED

7. CERTIFICATION ACTION (For JCO Use Only)

a. CERTIFICATION ACCEPTED. This certification number, along with a

b. NUMBER

c. EXPIRATION DATE

statement of intended data use, must be included with each request for

militarily critical technical data.

8. DOD OFFICIAL

9. CANADIAN OFFICIAL

a. TYPED NAME (LAST, First, Middle Initial)

b. TITLE

c. SIGNATURE

d. DATE SIGNED

c. SIGNATURE

d. DATE SIGNED

PREVIOUS EDITION IS OBSOLETE.

DD FORM 2345, MAR 2016

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Dd Form 2345 - Militarily Critical Technical Data Agreement

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