363/2011 Sb.
DECREE
of 23 December 2003. November 2011
about personal safety and security
415/2013: Sb.
The national security agency, establishes, pursuant to § 7 para. 3, § 9 para. 8, § 64,
§ 85 para. 5 and section 135 (a). a) to (f)), and (h)) to) Act No. 412/2005 Coll.
on the protection of classified information and the security of the eligibility, as amended by
amended, (hereinafter referred to as the "Act"):
§ 1
Patterns in the area of staff security and safety
(1) the model Declaration of the natural person pursuant to section 7 of the incapacitation the law is
listed in annex 1 to this notice.
(2) the model declaration relating to personal competence pursuant to section 13 of the Act is
listed in annex 2 to this Decree.
(3) the model Declaration of waiver of confidentiality pursuant to § 94
paragraph. 2 (a). (g)) and § 99 paragraph 2. 2 (a). (d)) of the Act is provided in annex No.
13 of this Decree.
§ 2
Patterns in the area of staff security
(1) the notice of compliance with conditions for access to classified information
classification of Reserved under section 6 of the Act is given in annex 3 to the
This Decree.
(2) the model lessons according to § 9 para. 1 and section 11 (1) 2 of the Act is set out in
Annex No 4 to this notice.
(3) the model of the application of a natural person pursuant to § 94 paragraph. 1 of the Act is set out in
Annex No. 5 to this Decree.
(4) the model questionnaire of the natural person pursuant to section 95 of the Act is given in annex
No. 6 to this Ordinance.
(5) the model of a natural person pursuant to § 54 para. 2 of the Act is set out in
Appendix 7 to this Decree.
(6) the model application for issue of a certificate of a natural person for a foreign power pursuant to §
paragraph 57. 2 of the Act is given in annex 8 to this Ordinance.
(7) the model application for recognition of the security permissions of the natural persons referred to in
§ 62 para. 2 of the Act is set out in annex 9 to this Decree.
(8) the model lessons according to § 58 para. 5 of the Act is provided in annex No 10 to
This Decree.
§ 3
Patterns in the field of security eligibility
(1) the model document requests under § 99 paragraph 2. 1 of the Act is given in annex
# 11 of this Decree.
(2) the model questionnaire pursuant to section 100 of the Act is set out in annex 6 to this
the Decree.
(3) the form of the document about the safety of natural persons according to § 85
the Act is given in annex 12 to this Decree.
§ 4
Justification natural persons according to § 94 paragraph. 1 of the law
Justification natural persons includes putting
and) function or activity within or leaving the
employment, the Member or the like relation, which has
be natural person certificate issued,
(b)) the Supreme classification classified information, which will have
natural person access,
(c) justification for the confirmation) requiring access to classified information
the responsible person, the safety Director or whoever will be the physical
person to provide classified information, including indications of a particular
places or features provided for pursuant to § 69 para. 1 (b). (b)) of the Act, and
the inclusion of this place or function in this overview,
d) specifications for classified information on a given site or function
have already been granted or arose, and classified information here
will be provided or can arise.
§ 5
Justification for the request of proof under § 99 paragraph 2. 1 of the law
Grounds for the application for the document includes putting
and the sensitive activity) has a natural person on the basis of the issued
document exercise,
(b)) the provisions of any other law, pursuant to which it will be exercised
sensitive activity,
(c) justification of performance sensitive) confirmation of the activities of the responsible person or
her legacy by a person, including a description of a place or feature
related to the performance of sensitive activities.
§ 6
A document pursuant to § 94 paragraph. 2 (a). (b)) of the Act to accompany a request
natural persons and documents pursuant to § 99 paragraph 2. 2 (a). (c)) of the Act
supporting the application of document
(1) a natural person to a natural person or to request an application for the document
be accompanied by a
birth certificate or baptismal) list, or other similar documents,
(b) proof of the highest) education,
(c) the employer's confirmation of income), indicating their amount after
deduction of compulsory statutory levies, income in the event of a different kind
tax return or any other document confirming the income for
the last 5 years,
(d) proof of the law of the sea) other person's restrictive ownership of the applicant, and
(e) the decision of the competent authority) regulation enforcement.
(2) the documents referred to in paragraph 1 (b). (b)), and (c)) of the natural person
presented in the original or in an officially certified copy thereof. The documents referred to in
paragraph 1 (b). a), d) and (e)) a natural person shall submit a copy of.
(3) the manner and form of submission of documents referred to in paragraph 1 are
laid down in § 9 para. 3.
§ 7
The request of the natural person pursuant to § 94 paragraph. 4 and 5 of the Act
(1) a natural person to the application filed pursuant to § 94 paragraph. 4 and 5 of the Act
a natural person shall be accompanied by the questionnaire individuals stating
Basic identification data), to the extent a name, surname, birth
If the number was not assigned, date of birth,
(b)), indicating their amount of income after deduction of compulsory statutory levies
for the period between the filing of the earlier application and
(c)) the data that has changed in the course of the validity of the certificate of physical persons
and have not been notified in accordance with § 10.
(2) the information referred to in paragraph 1 (b). (b)), and (c)) a natural person is illustrated by
the documents referred to in section 6 (1). 1 and 2, and the manner and form prescribed by
in section 9.
§ 8
A request for a document in accordance with § 99 paragraph 2. 4 and 5 of the Act
(1) the application for the document filed pursuant to § 99 paragraph 2. 4 and 5 of the Act, the physical
the person shall be accompanied by the questionnaire, stating
Basic identification data), to the extent a name, surname, birth
If the number was not assigned, date of birth,
(b)), indicating their amount of income after deduction of compulsory statutory levies
for the period between the filing of the earlier application and
(c)) the data that has changed in the course of the validity of the document and have not been
notified in accordance with § 10.
(2) the information referred to in paragraph 1 (b). (b)), and (c)) a natural person is illustrated by
the documents referred to in section 6 (1). 1 and 2, and the manner and form prescribed by
in section 9.
§ 9
The method and form of filing of applications and notification of changes
(1) the request of the natural person, the application for the document, the Declaration of waiver
obligations of confidentiality, representations of physical persons of incapacitation and
Declaration eligibility to the personality shall be submitted in paper form or
the data boxes are delivered to the national security authority or, in the
e-podobě1).
(2) a natural person and a questionnaire the questionnaire shall be submitted in paper form and
data are delivered to the mailbox of the national security office or in
electronic form in the format specified on the website
The National Security Bureau. The filing in electronic form can be done
even on a technical medium.
(3) the documents referred to in articles 6 and change notification under section 10 may be filed in
paper form or delivered to the mailbox of the national
Security Office or in electronic podobě1).
(4) electronic templates of the forms in annexes 1 to 6, 8 to 11
and 13 of this Decree published by the national security agency on its
website.
(5) the appearance of the paper form of the completed questionnaire by natural persons and
completed questionnaire must match the appearance of the display in the electronic
form.
§ 10
Limit the range of reporting changes in the questionnaire data of a natural person or, in the
questionnaire
(1) a natural person who filed the request of the natural person or the natural person
the person who made the request for the document, or the natural person who is
holder of a certificate issued by a natural person or document indicates
The National Security Bureau only changes
and identification data)
(b) the address of the place of residence),
(c)) the address for service,
(d)) of the employer,
e) belonging to associations, foundations and generally beneficial companies,
f) the acquisition or disposal of movable property whose value exceeds 100 000 CZK
or five times its average monthly income after the deduction of
compulsory statutory levies, whichever amount is higher,
(g)) the acquisition or disposal of immovable property,
h) criminal proceedings, including indication of when and by whom was initiated and
the reason,
I) regulation enforcement,
j) to achieve higher degrees of education,
the incurrence of liabilities), whose nominal value, individually or in the aggregate
exceeds 100 000 CZK, or five times its average monthly
income after deduction of compulsory statutory levies, according to which the amount of the
is higher,
l) the emergence of claims whose nominal value, individually or in
Summary exceeds 100 000 CZK, or five times its average
monthly income after deduction of compulsory statutory levies, according to
that amount is higher,
m) the particular installment of the commitment, if its value exceeds 100 EUR or
five times its average monthly income after deduction of compulsory
statutory levies, whichever amount is higher,
n) data to the person of husband (wife) or partner (partner) and people
over 18 years of age living at home with her; a natural person, which
the application for the document or is the holder of, a change of these data does not.
(2) a natural person declares in the range of items of a questionnaire of physical persons
referred to in annex 6 to this Ordinance changes referred to in paragraph 1 (b).
a) to (e)), h, i), and (n)). Natural person declares in the range of items
the questionnaire in Appendix 6 to this Ordinance changes referred to in paragraph
1 (b). a) to (e)), h and i). Fact pursuant to paragraph 1. I) to)
evidenced by a documents in the form set out in § 6 (1). 2 and the manner and
in the form laid down in section 9.
§ 11
Regulation (EEC)
Decree 527/2005 Coll. laying down patterns in the field of human resources
the safety and security of the eligibility and the lists of documents
accompanying the application for issue of a certificate of a natural person and to the request for
proof of the safety of natural persons, and method of administration
These requests (Decree on safety of personnel), is hereby repealed.
§ 12
The effectiveness of the
This Decree shall enter into force on 1 January 2000. January 2012.
Director:
Ing. He returned in r.
Annex 1
DECLARATION OF THE NATURAL PERSON OF INCAPACITATION
(section 7 of Act No. 412/2005 Coll.)
Name and surname:
Date of birth:
Address of residence:
1. I declare that I am – I'm not fully enjoys.
2. I declare that I am/was in the past and was not limited to-/and incapacitation.
3. in the event that you are in point 1 comment/and negatively or positively, in paragraph 2, please indicate:
and the name of the Court) that the relevant decisions issued:
...........................................................................................
...........................................................................................
(b)) reference number of the Court's decision:
...........................................................................................
...........................................................................................
(c)) the time period for which you have been limited in incapacitation:
...........................................................................................
...........................................................................................
V ....................... dne ....................
...............................
The signature of the
________________
* Delete where inapplicable
Annex 2
Model Of The Certificate Of ELIGIBILITY To The PERSONALITY
(section 13 of Act No. 412/2005 Coll.)
Name and surname:
Date of birth:
Address of residence:
1. I declare that I am-I'm not being treated by a psychiatrist and I-I'm not in the care of a psychologist.
I agree that in the past was not treated/and a psychiatrist, and was-not
in the care of a psychologist.
2. At present, I am not aware of the psychological difficulties.-
3. in the event that you are in points 1 and 2, expressed in the affirmative, please indicate/:
and) date of examination (time period)
...........................................................................................
(b)) the reasons which have led You to find a psychiatrist or psychologist
...........................................................................................
(c)) method of treatment-outpatient-inpatient hospitalization
...........................................................................................
d) Diagnosis
...........................................................................................
(e) the name of the professional device) name and surname of a psychiatrist or psychologist
...........................................................................................
(f) Please list all your psychological) difficulties and describe the circumstances occur (intensity,
the frequency, duration, treatment)
...........................................................................................
V ............ dne ............
........................
The signature of the
________________
* Delete where inapplicable
Annex 3
The model designation of the body
(give name and address of the authority of the State, a legal entity or business
natural persons)
ABOUT THE REMARK OF E N S
the fulfilment of the conditions for access to EU classified information to the level of classification of the reserved (§ 6 of the law No. 412/2005)
NOTICE
of compliance with the conditions for access to the RESTRICTED classified
information (section 6 of the Act n. 412/2005 Coll.)
Name and surname
Name and surname
Maiden name
Maiden name
Date of birth
Date of birth
Place of birth
Place of birth
Country of citizenship
Citizenship
V(In) ..................... Day (Date).....................
Compliance with the conditions referred to under section 6 (1). 2 Act No. 412/2005 Coll., on the protection of classified
information and security, as amended, issued and checked:
Compliance with conditions according to § 6 section 2 of the Act n. 412/2005 Coll., on the
protection of classified information and security eligibility, has been verified by and
the Notice has been issued by:
Name and surname
Name and surname
The signature of the
Signature
Stamp
Stamp
Annex 4
The model designation of the body
(give name and address of the authority of the State, a legal entity or business
natural persons)
P O U E N N S
According to § 9 para. 1/section 11 para. 2 of the law No. 412/2005 Coll., on the protection of classified information
and safety eligibility
BRIEFING
According to § 9 par. 1/section 11 par. 2 * of the Act n. 412/2005 Coll., on the
protection of classified information and security eligibility
The person below was familiar with its rights and obligations in the field of the protection of
of classified information. She was acquainted with the content of the law No. 412/2005 Coll., on the protection of
on the security of classified information and eligibility, as amended
(hereinafter referred to as the "Act") and with the content of the implementing legislation. Was made aware
with the obligations provided for in § and § 66 paragraph 65. 1 of the Act, in particular, with the obligation to:
The person named below has been briefed on his/her rights and duties in the area
of protection of classified information. He/she has been acquainted with the content
of the Act n. 412/2005 Coll., on the protection of classified information and security
eligibility (hereinafter "the Act"), and with the content of the implementing legal
regulations. He/she has been acquainted with duties laid down in § 65 and section 66 par. 1
of the Act, in particular with the following:
and to comply with the obligations laid down in) protection of classified information,
and comply with it) imposed obligations in protecting classified information;
b) keep confidential classified information that has or should have access, if it is not
exempted from this requirement by the competent authority,
(b)) that hold classified information in confidence, to which he/she has or had access,
unless he/she has been released from this duty by the responsible authority;
(c)) do not allow access to the classified information to any unauthorized person.
(c)) to prevent access by unauthorized persons that classified information.
There was familiar with all the consequences of the violation of the obligations provided for by law, in particular
with the danger of criminal prosecution or penalty for committing an administrative offense.
Further he/she has been briefed on all consequences arising from the breach of duties
imposed by the Act, in particular on the danger of a criminal prosecution or imposing
sanction for committing an administrative infraction.
The person below was acquainted with the regulations has not been NATO
was-transfer with EU regulations
It was not made aware of the provisions in SARA
The person named below:
has been-has not been * briefed on the regulations of the NATO
has been-has not been * briefed on the regulations of the EU
has been-has not been * briefed on the regulations of the SARA
V(In)................ dne (Date).....................
Lessons conducted by Knowledgeable person
The briefing made by The briefed person
Name and last name first name and last name
Name and surname, Name and surname
Signature date of birth
Signature Date of birth
Stamp certificate natural person/Number *
Stamp Number of Certificate of Security
Clearance/*
Release date announced
Issuance date of notice
The signature of the
Signature
________________
* Delete where inapplicable
Annex 5
The Pattern Of The REQUEST Of The NATURAL PERSON
(article 94, paragraph 1, of Act No. 412/2005 Coll.)
I request the issue of a certificate of physical persons
Name and surname:
Date of birth:
Place of birth:
Classification:
The justification for having access to EU classified information
(including functions or activities within or leaving the employment,
Member or the like relation, based on which the certificate is to be issued to natural persons):
...........................................................................................
...........................................................................................
I declare that the information provided in the application and its annexes is true,/and
I the terms safety control, and I agree with you.
V .................. dne .................
..................................
The signature of the natural person
Confirm the justification for the need for access to classified information
The designation of the responsible person/Safety Director or whoever will provide utajovanouinformaci
Designation of entity:
Name and surname:
Date of birth:
Access to classified information, a necessary result of filling determined pursuant to
§ 69 para. 1. (a). (b)) of the Act (specify the designation of the place or feature and inclusion in this list):
Specification of classified information on a given site or feature has already been provided or
arose, and classified information will be provided in the future or may arise:
...........................................................................................
V .................. dne .................
..................................
The signature of the
Stamp
________________
* Delete where inapplicable
Annex 6
A Model QUESTIONNAIRE INDIVIDUALS/QUESTIONNAIRE
(§ 95 of Act No. 412/2005 Coll.)
Photos
1. basic identification data
1.1 Name
1.2 Surname
1.3 maiden name
1.4 Previously used the surname
1.5 academic degree
1.6 date of birth
1.7 social security number
1.8. Place of birth
1.2 birth of District
1.10 the State of birth (if not Czech Republic)
1.11 the citizenship of current
1.12 country of citizenship the previous
1.13. Marital status
2. the address of the place of residence
2.1 Street
2.2 in no.
2.3 No./registration
2.4 the municipality
2.5 ZIP CODE
2.6 State
3. The address of another place where you stay or have stayed (and)
continuously for more than 90 days in the past ten years
3.1 Street
3.2 number
3.3 indicative Number/registration
3.4 the village
3.5 ZIP CODE
3.6 the State
3.7 Od do
4. the address for service and other contacts
4.1 Street
4.2 No.
4.3 indicative Number/registration
4.4 the municipality
4.5 ZIP CODE
4.6 State
4.7 Phone
4.8 Email
4.9. data mailbox ID
5. data on the identity document
(only for foreign nationals)
5.1 document type
(passport, identity card, etc.)
5.2 Number
5.3 State Edition
5.4 release date
5.5 Force to
6. the employer
6.1 the employer
6.2 identification number
6.3 Street
6.4 the number
6.5 Number guidance
6.6 the municipality
4.2 POSTAL CODE
4.2 Phone
6.9 the State
6.10 suggest that the job Description/features and activities
6.11 Employed from
7. Previous employers
and in the last 10 years) in the case of an application of a natural person for the classification of Confidential
and requests for the document, or for the period from 15 years of age, depending on which is shorter
(b)) in the last 15 years in the case of a request of the natural person for security classification secret
or for the period from 15 years of age, depending on which is shorter
(c)) in the last 20 years in the case of an application of a natural person for the classification of top secret,
or for the period from 15 years of age, depending on which is shorter
7.1 the employer
7.2 identification number
7.3 Employed (a) from The
7.4 if any further clarification, if you cannot give the exact name of the employer and the identification number
8. jurisdiction to foundations, associations, and generally beneficial companies in
the last 5 years
8.1 Name
8.2 identification number
5.2 From The
5.2 Features
9. The matrimonial property regime
5.7 Persons financially dependent on you
9.1.1 Name
9.1.2 Surname
9.1.3 birth number/date of birth, social security number, if it is not allocated
9.1.4 relationship to your person
9.2 the common property of the spouses
Yes No
9.3. Matrimonial property regimes
(in the case of a positive reply in detail, specify)
Yes No
5.8 Finance
(bank accounts, insurance policies, savings accounts and credit
cooperatives, life insurance, pensions, savings, and other financial products, and disposition
the rights to the account of other persons, with the exception of item 9.4.4)
9.4.1 the type of
9.4.2 the number
9.4.3 the
9.4.4. The current balance
9.4.5 Currency
any additional observations 9.4.6
9.4.7 Above regular deposit of the natural person
9.5 Investment tools
(pursuant to section 3 of Act No. 256/2004 Coll. on the capital market,
as amended)
9.5.1 the kind of
9.5.2 ISIN
9.5.3 identification of Other investment tools
9.5.4 unit cost
9.5.5 Currency
9.5.6 method and date of
9.5.7 any additional observations
6.0 annual income after deduction of compulsory statutory levies for the past 5 years, in the case of the submission of
the request pursuant to § 94 paragraph. 4 and 5 of the Act or under § 99 paragraph 2. 4 and 5 of the Act for the period, which
Since putting this information in a previous application
9.6.1 9.6.2 9.6.3 Amount Currency Year
6.0 other income other than wages or salary less the compulsory statutory levies for the past 5 years,
in the case of a request referred to in section 94 para. 4 and 5 of the Act or under § 99 paragraph 2. 4 and 5 of the Act for the period
Since the launch of these data in the previous application (výsluhový post, receive
from a business, rental income, income from the sale of immovable property, income for the stay in a foreign
Mission, social benefits, unemployment benefits, maternity allowance, maintenance, gifts, inheritance, etc.)
9.7.1 Year 9.7.2 sort of 9.7.3 9.7.4 Currency Above
6.1 movable property
(depending on the species, whose value in the case of one species exceeds 100 000 CZK, e.g., personal collection
car, antiques, equipment, electronics)
9.8.1 the kind of
9.7.2 the number of pieces
9.8.3 the total value
6.2 real estate
9.9.1 shall be conducted at the land registry office (in the case of real estate outside of the Czech republikuuveďte address)
9.9.2 real estate Description and method of its use
9.9.3 Way acquisition
9.9.4 Custom price estimate
9.9.5 the acquisition price
9.9.6 Currency
9.10 the relationship to the object of housing
9.10.1
The owner/co-owner of the payer of the rent of housing cooperatives
staying free of charge other
9.10.2. Average monthly housing costs (rent, payments for services connected with the operation of an object housing)
9.11 financial receivables
9.11.1 legal reason
9.11.2 Above
9.11.3 Currency
9.11.4 the debtor
9.11.5 any additional observations
9.12. Financial liabilities
9.12.1 legal reason
9.12.2 Above
9.12.3 Currency
9.12.4 the creditor
9.12.5 the average monthly payments
any additional observations 9.12.6
10. Criminal proceedings
State all criminal prosecutions were conducted against you, regardless of theresult
control any expungement of punishment and the certificate is in the conditional sentences, including shortened procedure.
10.1 the legal designation of an offence
10.2 Date commencement of prosecution
10.3 the prosecution led the (designation authority participating in criminal proceedings, the file marks, number)
10.4 the date and the method of their
10.5 a detailed statement
11. the Mandated enforcement
(execution, deductions from wages, assets, etc.)
6.9 the authority which ordered the execution of decisions
11.2 the kind of
11.3 the Year regulation enforcement
7.1 detailed statement
12. Highest completed education
12.1 name of the school
12.2 the municipality
12.3 State
7.7 Year end
12.5 Degree education
13. Continuous stay abroad longer than 90 days
13.1 State
13.2 place of residence
13.3. Detailed comments on the stay (reason, who sent the funds to cover the costs of the stay, etc.)
13.4 from to
14. Personal contacts with foreign nationals or nationals
the citizens of the United States living in non-Member States of the European Union
or the North Atlantic Treaty Organization, with the exception of contacts
arising out of employment or official duties after 1990,
If you can reasonably assume that it is a significant contacts
14.1 detailed statement
15. jurisdiction, contacts and links with the former and current security
the services of a foreign power or its services in the news and on the
the ingredients listed in § 14 para. 3 (b). and) law, except for contacts
arising out of employment or official duties after 1990
(i.e. the former State security folder with rozvědným or kontrarozvědným
focus, including military counterintelligence, intelligence management
The General staff of the Czechoslovak people's army or the Department of the Interior
Protection Corps remedial education.)
15.1. A detailed statement of
16. use of narcotic drugs or psychotropic substances, as referred to in the Act
governing the area of substance abuse and alcohol use, playing on
licenced and participating in betting games or treatment
addiction to narcotic drugs or psychotropic substances, alcohol and treatment
compulsive gambling
16.1 the narcotic or psychotropic substances
16.1.1 the kind of
16.1.2 detailed statement (with regard to the frequency of use, in the past and in the present, including
a one-time experience, applied/used the types and quantities of narcotic drugs and psychotropic substances, etc.)
10.1 Alcohol
16.2.1 a detailed statement
16.3. Playing on the slot machines, and participation in betting games
16.3.1 detailed statement (with respect to the frequency in the past and in the present, a kind of game,
inserted/pasted amounts, etc.)
10.2 Treatment of addiction to alcohol, narcotic drugs and psychotropic substances, treatment of pathological
gambling, and it's in the past or in the currently
16.4.1 detailed statement
17. The previous security management
(security screening, authentication, security)
17.1 the confidential, secret, top secret, security eligibility.
17.2 the outcome of proceedings Stopped in top ten best-seller Released
17.3. the authority of the State, that the proceedings were conducted by the
18. A detailed curriculum vitae
Write free form. We recommend the following breakdown: family,
school and preparing for employment, existence, independence and partnership
family life, employment, any business activity, operation
business, membership in the organs of legal persons, the way of leisure
of time, physical and mental health. In the case of an application pursuant to § 94 paragraph. 4 and
5 or under § 99 paragraph 2. 4 and 5, limit the content of the resume for the period from
of the earlier application.
19. the husband (ka) or partner (ka) and persons over the age of 18 living in the
a household with a natural person
(does not fill in the application for the document)
19.1 the name,
19.2 last name
12.0 maiden name
19.4 Previously used the surname
12.1 date of birth
12.2 your social security number
12.2 place of birth
12.3 the County of birth
12.4 the State of birth (if not Czech Republic)
19.10 the citizenship of current
19.11 the citizenship of the previous
19.12 the relationship to your person
19.13 the employer
19.14 the identification number
19.15 argued for a detailed description of job/function
19.16 Employed from
Annex 7
The model designation of the body
(enter the name of the body issuing the certificate)
O WITH A D E N N S
natural persons
Certificate of Security Clearance/Certificat d ' habiliation personnelle
Number:
Number/Numéro
Name and surname
Name and Surname
Nom et prénom
Maiden name
Maiden Name
Nom de naissance
Date of birth social security number
Date of Birth Personal Well.
Date de naissance Numéro d ' identification personnele
Place of birth
Place of Birth
Lieu de naissance
Country of citizenship
Nationality
The Belgian
Classification level
Classification Level
Niveau de classification
Release date valid from valid until
Date of Issue Valid from Date of Expiry
Date de délivrance de Validité á partir d ' expiration Date
Signature of the authorized representative of the imprint of the official stamp
The signature of the Competent Representative Official Stamp/Cachet offciel
Signature du représentant autorisé
Annex 8
Pattern For Issuing A Certificate Of A NATURAL PERSON For A FOREIGN POWER
(article 57, paragraph 2, of Act No. 412/2005 Coll.)
I request the issue of a certificate of a natural person for a foreign power:
A. identification data:
Name and surname:
Date of birth:
Place of birth:
B. classification, for which the certificate is of a natural person for a foreign power required:
...........................................................................................
(C) a valid certificate number of the natural person and the classification level for which it is issued:
...........................................................................................
(D) the rationale for buying access. a natural person to the classified information to a foreign power (including the
position held, the nature of the activities in which the natural person will have access
the classified information to a foreign power, the identification of the body which will be the physical person classified
information to a foreign power to provide):
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
E. the period for which a natural person is sought to issue the certificate for a foreign power:
...........................................................................................
(F) the address for service:...........................................................
V ..................... dne .....................
.....................
The signature of the
Annex 9
Pattern RECOGNITION Of SECURITY PERMISSIONS To Request Of The NATURAL PERSON
(article 62, paragraph 2, of Act No. 412/2005 Coll.)
I ask for the recognition of the security permission issued for natural persons:
The name or names, and surname:
Date and place of birth:
Country of citizenship:
Based on the security permissions no........................................... issued by
...........................................................................................
(The name of the issuing institution and the State)
day.............. valid until.............. classification ... ... ... ... ... ...
The reason why it has to be a recognition of the security permission is carried out (including the position held, the nature of the activities in which the natural person will have access to EU classified information, the identification of the person who will be the person to provide classified information):-...-----------------------..
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
The period for which recognition is to be done:..................................................
Address for service of the recognition of the security permissions of a natural person:
...........................................................................................
...........................................................................................
...........................................................................................
Annex: an official translation of the security permission issued by a foreign power or its certified copy
or confirmation of the Office of a foreign power, that is in the scope of protection of classified information, that
the applicant is in possession of the appropriate security permissions.
V .............. dne ..............
..........................................
Signature of the holder bezpečnostníhooprávnění
or of the person responsible of the Office of foreign
power, which is in the scope of protection
of classified information
Annex 10
The model designation of the body
(give name and address of the entity in which the proceedings are conducted)
P O U E N N S
According to § 58 para. 5 of law No. 412/2005 Coll., on the protection of classified information and the security of the eligibility
The person below was familiar with its rights and obligations in the field of the protection of classified
information. She was acquainted with the content of the law No. 412/2005 Coll., on the protection of classified information
and about security, as amended by later regulations (hereinafter referred to as the "Act") and the content
the implementing legislation. There was familiar with the obligations that are stipulated in sections 65 and
section 66 paragraph 1. 1 of the Act, in particular, with the obligation to
and to comply with the obligations laid down in) protection of classified information,
b) keep confidential classified information that has or had access to, unless this
exempted from the obligation by the competent authority,
(c)) do not allow access to the classified information to any unauthorized person.
There was familiar with all the consequences of the violation of the obligations provided for by law, in particular
resulting in a criminal prosecution or penalty for committing an administrative offense. Was also
advised that the details of the national security authority are recorded and may be used
manner prescribed by law.
The lesson is done for the purposes of...........................................................
(enter the name of the procedure)
kept under....................................... In this proceeding will have an educated person
(enter the file description of the case)
access to classified information up to the classification of..................................., including,
a to z oblasti ....................................................
V ................ dne ................
Lessons conducted by Knowledgeable person
Name and surname: first name and surname:
Signature: date of birth:
Stamp
Signature:
Annex 11
A Model Request For DOCUMENT
(article 99, paragraph 1, of Act No. 412/2005 Coll.)
I ask for the release of the document on security of natural persons:
Name and surname:
Date of birth:
Place of birth:
Sensitive activities:
...........................................................................................
...........................................................................................
The provisions of the law, according to which it will be exercised in such a sensitive activity:
...........................................................................................
...........................................................................................
I declare that the information provided in the application and its annexes is true, I
the terms of the safety control, and I agree with you.
V .................. dne ..................
....................................
The signature of the natural person
Confirm the justification for the performance of activities including a description of a particular sensitive places or features
related to the performance of sensitive activities:
...........................................................................................
...........................................................................................
The responsible person or the authorized person
Designation of entity:
Name and surname:
Date of birth:
V .................. dne ..................
....................................
The signature of the
Stamp
Annex 12
Pattern
THE NATIONAL SECURITY AGENCY
Post offices. compartments. 49 150 06
Prague 56
(D) TO (L), AND (D)
about the safety of natural persons
Number:
Name and surname:
Maiden name:
Birth date: social security number:
The place and State of birth:
Country of citizenship:
Release date: valid from: valid until:
Signature of the authorized representative of the imprint of the official stamp
The National Security Office, the National Security Office
Annex 13
Model Declaration Of WAIVER Of CONFIDENTIALITY
pursuant to § 52 para. 2 the tax code
The data to the physical person requires the national security agency in the framework of the implementation of the operations of the security
proceedings under Act No. 412/2005 Coll., on the protection of classified information and security
eligibility, as amended.
The tax entity
Name and surname:
Maiden name:
Social security number:
Date of birth:
I, the undersigned (s), zprošťuji tax administrator and any other person involved in the správědaní obligations
secrecy concerning the data relating to me, and the data that were used in the taking of evidence
duties in the administration of taxes, to the extent necessary for carrying out safety control by
Act No. 412/2005 Coll., on the protection of classified information and the security of the eligibility, as amended by
amended.
I agree, that the tax or any other person involved in the administration of taxes was totozproštění
confidentiality provided a copy to the confirmed national security authority.
V .................. dne ..................
....................................
The signature of the
