Annex AB: Example Conformance Statement

ARCS v1.0

STANDARD ANNEX AB

March 2026 | Informative Annex

Classification: Tier 1 / Standard Annex / Informative

Standard Annex AB: Example Filled Conformance Statement

Illustrative Conformance Statement per Section 4 and Annex I (Informative)

This annex provides an example of a completed conformance statement. The format follows Standard Annex I. This annex is informative.

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Field Value

System name Example Enterprise AI Assistant

Operator Example Corporation

Deployment mode Enterprise web interface + API + agent workflow

Version / configuration v2.4.1 / enterprise-configured / agent-enabled

Date of assessment March 7, 2026

Declared conformance Level 4 (enterprise); Level 5 (agent workflow) level

Excluded components User local device storage (S-04, S-05): outside operator control

Known non-conforming Plugin vendor (S-13): retention unknown. Tool components vendor (S-15): retention unknown.

Responsible assessor J. Smith, Chief Information Security Officer

Record-bearing 16 surfaces (S-01 through S-16) components assessed

Record surface map v3.1, dated March 5, 2026 version

Custody surface map v2.0, dated March 5, 2026 version

Configuration matrix v2.0, dated March 5, 2026 version

Routing table version v1.3, dated March 5, 2026

Preservation override Yes documented

Unknown surfaces Yes (S-13, S-15) identified

Fragmented custody Yes

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Declaration: The undersigned states that the above assessment was performed in accordance with ARCS v1.0.

Signature: ___________________________ Date: _______________

ARCS v1.0 | Annex AB: Example Filled Conformance Statement | March 2026 | Informative