STATEMENT OF CONTRACTOR COMPLIANCE WITH
THE NORTH CAROLINA IDENTITY THEFT PROTECTION ACT OF 2005
____________________________________ (“Contractor”) hereby certifies that,
[Name of University Contractor]
pursuant to section 4(c)(1) of North Carolina General Assembly Session Law 2005-414 (to be
codified at section 132-1.8(c)(1) of the North Carolina General Statutes), the text of which is
available at http://www.ncga.state.nc.us/Sessions/2005/Bills/Senate/HTML/S1048v6.html,
Contractor’s collection of social security number information from East Carolina University (the
“University”) is necessary for the performance of Contractor’s duties and responsibilities on
behalf of the University. Contractor further certifies that it shall maintain the confidential and
exempt status of such social security number information, as required by section 4(c)(1).
By:
______________________________________________
[Signature of Contractor]
Name:
______________________________________________
[Printed name]
Title:
______________________________________________
Date:
______________________________________________
University Dept.: ___________________________________
Dept. No. ________
Submitted on behalf of the University Dept. by: ________________________________
[Printed name]