Device Data Decommissioning Form - FCI Cyber

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Confirmation of Workstation Data Decommissioning

Complete this form for the decommissioning of devices that
contained nonpublic information (NPI).

Firm
Firm Name:*
CISO/ISO/ISL Name:*
CISO/ISO/ISL Email:*
Computer Information
Computer Name:*
Computer Serial Number:*
Hard Drive Serial Number:*
Computer Owned by:*
- Firm
- Individual
Computer Owned by Name:*
Phone:*
Email:*
Individual is still associated with the Firm:*
- Yes
- No
Decommissioning Options
Decommission Request Date:*
MM slash DD slash YYYY
Select One Option:*
- Option 1: Hard Disk Was Destroyed
- Option 2: Hard Disk Was Securely Wiped & Prepared for Reuse
- Option 3: Request to Remove Firm's Security Management Services (FCI Protectit)
- Option 4: Request to Lockdown Computer to Block Access to NPI
Option 1: Hard Disk Was Destroyed
Hard disk was encrypted before destruction:*
- Yes
- No
Destruction evidence was saved in Cyber Folder:*
- Destruction certificate from a third-party
- Picture taken during destruction
Notes
Option 2: Hard Disk Was Securely Wiped & Prepared for Reuse
Hard disk was encrypted before security wipe:*
- Yes
- No
An external USB Drive was used to wipe/format/rebuild the hard disk (a process that overwrites the entire hard disk with zeros or random characters thus rendering it unreadable):*
- Yes
- No
New Computer Name:
Notes:
Option 3: Request to Remove Firm's Security Management Services (FCI Protectit)
Attestation:*
- Hard Disk was inspected by the Firm and NPI was removed from computer
- Other (add explanation in the Notes field below)
Attestation:*
- Hard Disk was inspected by the Firm and NPI was removed from computer
- NPI retained by computer owner as per agreement with the Firm
- Firm got a signed attestation from computer owner confirming NPI was removed from computer and will not be restored on any computer
- Other (add explanation in the Notes field below)
Attestation:*
- Hard Disk was inspected by the Firm and NPI was removed from computer
- Firm got a signed attestation from computer owner confirming NPI was removed from computer and will not be restored on any computer
- Other (add explanation in the Notes field below)
Notes:
Attestation Form
Download the attestation form

The attestation signed by the computer owner must be attached to the decommissioning ticket email and sent to FCI.
Attestation Form
Download the attestation form

The attestation signed by the computer owner must be attached to the decommissioning ticket email and sent to FCI.
Option 4: Request to Lockdown Computer to Block Access to Computer
Request FCI to put the computer in Lockdown Mode (which will make the computer unusable until the Recovery Key is entered) on:
MM slash DD slash YYYY
Notes:
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07003

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MANAGED SERVICES

Managed Endpoint Protection

Computer, Server, Smartphone, and Tablet

Managed Network Protection

Firewall, WiFi, and Remote Communication

Safeguard Scanning & Evidencing

Domain, Cloud, Network, and Endpoint

Other Services

Professional Services

Co-Managed Cybersecurity Services

CISO & Security Personnel Compliance Support

Hardening Services

Cyber Strategy Consulting

Digital Cyber Forensics Services

Cybersecurity Integration as a Service

Secure Synchronization Platform

NIST-Based Solutions

IDENTIFY

Zero Trust Complete

Evidence of Compliance

Protect

Managed Endpoint & Network Protection

Data Exfiltration Protection

Detect & Respond

Managed Detection & Incident Response

Recover

Event Recovery & Breach Support

CYBER-REGULATED INDUSTRIES

FINANCIAL SERVICES

Life, P&C, and Health Insurance

Carriers, Brokers, Agencies

Commercial Cyber Insurance

Wealth

Broker Dealers, IBDs, RIAs, Hedge Funds

Banking

Retail, Mortgage Bankers, Brokers, Credit Unions

Government Contractors

Hospitals, Clinics, Practitioners

Other Cyber-Regulated Industries

Others

With a commitment to cybersecurity

Serving Cyber-Regulated Industries

Software Vendors

Law, Compliance, and Consulting Firms

Accounting Firms

COMPANY

About

Team

Media & Press Kit

Working at FCI

privacy

Security & Privacy Policy

Privacy Notice

FCI SOAR PLATFORM

Security Orchestration

Security Automation

Security Response

OTHER

Financial Planning Association

Free Cybersecurity Audit Preparedness Assessment

Are you ready for a cyber audit?

Confirmation of Workstation Data Decommissioning

Firm

Computer Information

Decommissioning Options

Option 1: Hard Disk Was Destroyed

Option 2: Hard Disk Was Securely Wiped & Prepared for Reuse

Option 3: Request to Remove Firm's Security Management Services (FCI Protectit)

Attestation Form

Attestation Form

Option 4: Request to Lockdown Computer to Block Access to Computer

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(888) 434-6443

400 Broadacres Drive Suite 270 Bloomfield, NJ 07003

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400 Broadacres Drive
Suite 270
Bloomfield, NJ
07003