Annex H: Conformance Statement Template

ARCS CONFORMANCE STATEMENT

System name: _______________
Operator / deploying entity: _______________
Deployment mode(s): _______________
Version / configuration identifier: _______________
Date of assessment: _______________
Declared conformance profile: _______________

Excluded components (with justification):
_______________

Known non-conforming components:
_______________

Responsible assessor: _______________
Assessment type: [ ] Operator self-assessment  [ ] Internal audit  [ ] Third-party assessment

Record-bearing components assessed:
_______________

Record surface map version and date: _______________
Custody surface map version and date: _______________
Configuration matrix version and date: _______________
Routing table version and date: _______________

Preservation posture documented: [ ] Yes  [ ] No
Unknown surfaces identified: [ ] Yes  [ ] No  [ ] None
Fragmented custody: [ ] Yes  [ ] No

Non-creation claims made: [ ] Yes (NCR controls required)  [ ] No

Declaration: The undersigned attests that the above assessment was performed
in accordance with ARCS v1.0 (Automated Record Custody Standard).

Signature: _________________________ Date: _____________
Name: _____________________________
Title: _____________________________
Organization: ______________________