Prime Contract Number: Program: The Supplier asserts for itself, or the persons identified below, that the Government’s rights to use, release, or disclose the following technical data should be restricted. Item Use Technical Data to be Furnished with Corresponding Item, Basis for Assertion Asserted Rights Name of Person Asserting Rights Restrictions Component, or Category Process Date Title Printed Name Signature:
Prime Contract Number: Program: The Supplier asserts for itself, or the persons identified below, that the Government’s rights to use, release, or disclose the following technical data should be restricted. Item Use Technical Data to be Furnished with Restrictions Corresponding Item, Component, or Process Basis for Assertion Asserted Rights Category Name of Person Asserting Rights Date Title Printed Name Signature:
f360.docx