Appendix A to Part 512 - Certificate in Support of Request for Confidentiality
49:6.1.2.3.6.7.1.1.2 : Appendix A
Appendix A to Part 512 - Certificate in Support of Request for
Confidentiality Certificate in Support of Request for
Confidentiality
I _____, pursuant to the provisions of 49 CFR part 512, state as
follows:
(1) I am (official's name, title) and I am authorized by
(company) to execute this certificate on its behalf;
(2) I certify that the information contained in (pertinent
document(s)) is confidential and proprietary data and is being
submitted with the claim that it is entitled to confidential
treatment under 5 U.S.C. 552(b)(4) (as incorporated by reference in
and modified by the statute under which the information is being
submitted);
(3) I hereby request that the information contained in
(pertinent document(s)) be protected for (requested period of
time);
(4) This certification is based on the information provided by
the responsible (company) personnel who have authority in the
normal course of business to release the information for which a
claim of confidentiality has been made to ascertain whether such
information has ever been released outside (company);
(5) Based upon that information, to the best of my knowledge,
information and belief, the information for which (company) has
claimed confidential treatment has never been released or become
available outside (company); (except as hereinafter specified);
(6) I make no representations beyond those contained in this
certificate and, in particular, I make no representations as to
whether this information may become available outside (company)
because of unauthorized or inadvertent disclosure (except as stated
in paragraph 5); and
(7) I certify under penalty of perjury that the foregoing is
true and correct. Executed on this the ___ day of ___, ___. (If
executed outside of the United States of America: I certify under
penalty of perjury under the laws of the United States of America
that the foregoing is true and correct). (signature of
official)