Attachment E Affidavit of Nondisclosure Draft.docx

Attachment E Affidavit of Nondisclosure

(Name)

(Job Title)

(Email address) (Telephone number)

(Institution/Research organization/Contractor) (Address of Institution/Research organization/Contractor)

I, do solemnly swear (or affirm) that when given access to U.S. Energy Information Administration (EIA) confidential data in the ______________ Report survey, I will not:

(1) Make any disclosure or publication whereby the data furnished by or related to any particular respondent could be identified.

(2) Disclose any information about summary results prior to the public release of the report;

(3) Engage in financial transactions using confidential report information or allow the improper use of such information to further any private interest;

(4) Duplicate or remove any company level proprietary EIA information from the approved physical facility where the confidential information are stored without prior written approval by EIA.

I certify that I am currently a contractor with U.S. Energy Information Administration assigned to work on the ____________________ Report.

(Signature)

City/County of _______________ STATE OF ss:

Before me, the undersigned notary public, personally appeared whose name is signed to the foregoing affidavit, and after being first duly sworn under oath by me, declared to me and in my presence that he/she willingly signed and executed it as their free and voluntary act for the purposes therein expressed.

Subscribed, sworn and acknowledged before me on this th day of , 2013 .

Witness my hand and official Seal.

Notary Public

My commission expires____________________ (SEAL)