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I. DATE SIGNED YYYYMMMDD 2. REGISTRATION OFFICIAL PER CPS I have personally verified the identity of the person above in accordance with the applicable CPS and have personally witnessed that person sign the form. DD FORM 2842 AUG 2009 PREVIOUS EDITION IS OBSOLETE. A copy of this form shall be provided to the Subscriber. SUBSCRIBER DEPARTMENT OF DEFENSE DOD PUBLIC KEY INFRASTRUCTURE PKI CERTIFICATE OF ACCEPTANCE AND ACKNOWLEDGEMENT OF RESPONSIBILITIES a* NAME Typed or printed Last First Middle Initial b. UNIQUE IDENTIFICATION e*g* EDIPI UID c* ORGANIZATION e. E-MAIL ADDRESS d. TELEPHONE NUMBER Include Area Code PRIVACY ACT STATEMENT AUTHORITY 5 U*S*C. 301 Departmental Regulation 44 U*S*C. 3101. PRINCIPAL PURPOSE S To collect personal identifiers during the certification registration process to ensure positive identification of the subscriber who signs this form* ROUTINE USES Information is used in the DOD PKI certificate registration process. DISCLOSURE Voluntary however failure to provide the information may result in denial of issuance of a token containing PKI private keys. You have been authorized to receive one or more private and public key pairs and associated certificates. A private key enables you to digitally sign documents and messages and identify yourself to gain access to systems. You may have another private key to decrypt data such as encrypted messages. People and electronic systems inside and outside the DoD will use public keys associated with your private keys to verify your digital signature or to verify your identity when you attempt to authenticate to systems or to encrypt data sent to you. The certificates and private keys will be issued on a token for example a Common Access Card CAC another hardware token or a floppy disk. The certificates and private keys on your token are government property and may be used for official purposes only. Acknowledgement of Responsibilities I acknowledge receiving my PKI private keys and will comply with the following obligations - I will use my certificates and private keys only for official purposes - I will comply with the instructions described to me today for selecting a Personal Identification Number PIN or other required method for controlling access to my private keys and will not disclose same to anyone leave it where it might be observed nor write it on the token itself - I understand that if I receive key management encryption/decryption key pairs on my token copies of the private decryption keys have been provided to the key recovery database in case they need to be recovered and - I will report any compromise e*g* loss suspected or known unauthorized use misplacement etc* of my PIN or token to my supervisor security officer Certification Authority CA Registration Authority RA Local Registration Authority LRA Trusted Agent TA or Verifying Official VO immediately. Liability I will have no claim against the DoD arising from use of the Subscriber s certificates the key recovery process or a Certification Authority s CA s determination to terminate or revoke a certificate.

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