Request to Withdraw from an ADISA Certification Scheme

Company Name *

Approval Number

Certification Scheme *ADISA ICT Asset Recovery Scheme 8.0 (UK)

Facility Address to be Withdrawn *0 / 500

Person making withdrawal request Name *

Job Title *

Phone *

E-mail *

Please provide details on the reason for withdrawal. *

Please provide date withdrawal is required. *0 / 500

If you would like a response, please include your email below *0 / 500

Confirmation of understanding. *Confirm understanding of withdrawal.* I must cease the use of the certification mark. * I must make no further reference to certification. * I must inform data controller or data processors of the withdrawal in all instances where certification was stated during the engagement process. * Please note that ADISA will notify the ICO about the withdrawal if certified under Standard 8.0 UK.

PRINT NAME *0 / 500