SECRET

PERSONALITY FILE ACTION REQUEST

NOTE: See instructions on reverse side of form. Type or print all entries. Submit original and 2 copies to control section of CIB.

To: RID/201 Section TYPE STATION FILE: ACTION:

FROM: NAME: (Last) (First) (Middle)

RESTRICTED PERMANENT FILE CANCEL

ID NO. 201 NO. SOURCE DOCUMENTS DATE

NAME IDENTICALS:

NAME: (Last) (First) (Middle)

NAME: (Last) (First) (Middle)

SEX: M F

DATE OF BIRTH: PLACE OF BIRTH:

ORGANIZATION OR INTELLIGENCE AFFILIATION CODE:

OCCUPATION (Cover Type) CODE:

ACTION TAKEN CODE: SECONDARY CODE:

COMMENTS:

HAND CARRY IF TRUE NAME APPEARS ABOVE

SIGNATURE: DATE:

SECRET

FORM 831 1-67