Exhibit J - ASG-KU DES FORM 190-16.06 ENCLOSURE 13.pdf

ASG‐KU Smart Device(s) Supplement Form

SECTION I ‐ SMART DEVICE(S) INFORMATION

Description of Areas/Items "Official Business Only Photographs (must include # of SIM Cards device is capable of supporting): "Official Business Only" Photography:

■ Yes No

Manufacturer: Model/Serial Number: SIM Card Serial Number/IMEI:

Manufacturer: Model/Serial Number: SIM Card Serial Number/IMEI:

Manufacturer: Model/Serial Number: SIM Card Serial Number/IMEI:

SECTION II ‐ SMART DEVICE OWNER OWNER

Last Name: First, Middle Initial: Company/Unit:

Title and/or Position: Passport Number: Kuwait Civil ID Number:

SECTION III ‐ COR / APPOINTED AUTHORITY (AA) INFORMATION AND RECOMMENDATION

AA Last Name: AA First, Middle Initial: AA Rank/Grade

AA Unit/Organization: AA Work Number (DSN): AA Mobile Number:

AA Email Address: AA Signature and Date:

SECTION IV ‐ SMART DEVICE AND OPERATIONS SECURITY ACKNOWLEDGMENT

Data Required by Privacy Act of 1974 (5 U.S. CODE 552a)

AUTHORITY: AR 190-16, AR 600-8-14, AR600-8-104, USCENTCOM OPORD 10-05 Antiterrorism, AFR 207-4, OPNAVINST 5530.15a, MCO 5500.13a, DoD 1000.13p, ASG-KU Installation Access Policy, ASG-KU Prohibited Item Policy.

PRINCIPAL PURPOSE: To evaluate an applicant requesting an exception to specific requirements of ASG-KU policies related to Installation Access.

MANDITORY DISCLOSURE REQUIREMENT: Failure to provide the required information, including passport number or Kuwait Civil Identification number will result in disapproval of this application. Exceptions may require additional screening, interview and background checks. Any derogatory information returned from the applicant's background investigation or failure to comply with screening/interview requirements may result in denial of exception and barment proceedings being initiated.

Acknowledgment of ASG‐KU Installation Smart Device and Operations Security Responsibilities As an ASG‐KU Installation Individual with an Approved Prohibited Item Exception, I acknowledge the following:

1. I understand that upon entering, exiting or while on any ASG‐KU Installation the Smart Device(s), including all contents, is subject to search at the discretion of the U.S. Government, its designate or the issuing agency.

2. I understand I am subject to additional screenings, interviews and background checks to receive an exception of policy.

3. I understand upon request I am responsible for providing full access to my Smart Device(s) (i.e. my password/passcode or other login information) to law enforcement, or security personnel.

4. I understand that all photographs are for "Official Business Only" and any photographs deemed otherwise are in violation of ASG-KU Operation Security Policy.

5. While on post, I understand the Approved Prohibited Item Exception must be carried at all times and presented to military, law enforcement, or security personnel upon request.

6. While on post, I understand that I am the only authorized sole user of the Smart Device(s) listed above.

7. I understand I must immediately report if my Approved Prohibited Item Exception or Smart Device(s) is lost, stolen or if components of the phone i.e. (SIM Card) are repaired or replaced.

8. I will not copy, photograph or provide my Approved Prohibited Item Exception to anyone other than military, law enforcement, or security personnel.

9. I acknowledge by my signature that I have read and understand the policy, requirements and responsibilities above.

(Print) Owner's Last, First, Middle Initial: Owner's Signature: Date (DD‐MMM‐YY):

SECTION V ‐ INSTALLATION ACCESS USE ONLY

Application Inspected By: Signature and Date of Person Verifying Application: Expiration Date of Exception of Policy

(DD‐MMM‐YY):

Verified Documents Enclosed:

Copy of Enclosure 10 Copy of Justification Memo Enclosure 7

Enclosure 13 ‐ ASG‐KU DES Form 190‐16.06_Smart Device(s) Supplemental Form (1 November 2022)

Manufacturer: Model/Serial Number: SIM Card Serial Number/IMEI:

SECTION III ‐ COR / APPOINTED AUTHORITY (AA) INFORMATION AND RECOMMENDATION

DBIDS #

of Smart Device Owner