NWB On-Site Decommissioning Sign-Off V1.2

General Information

• Site Name:

• ATM Address / Location (including Post Code):
  Address

• ATM Model:

• ATM Serial Number:

• Customer ATM LU Number:

• On Site Time:

  Date

• Confirmed with NCR IC (please insert NCR IC`s name)

NWB Mandatory Compliance Checks

• PC Core Taper Label Serial Number:

• PC Core Tamper Label Intact and Secure?

  Yes

  No

• EPP Serial Number:

• Serial Number of the Tamper Proof Security bag EPP put in?

• Return Trace Reference Number?

• HDD Serial Number:

• Serial Number of the Tamper Proof Security bag HDD put in?

• Return Trace Reference Number?

• Any Additional Comments?

Sign Off - To be signed off by Customer Representative & Engineer on completion of all tasks:

Customer Representative:

• Name (Signed)

  Sign

• Date and Time

  Date

• Comments?

Engineer:

• Name (Signed)

  Sign

• Date and Time

  Date

• Comments?

• Prior to sending removed EPP and HDD for destruction please consult your NCR IC for the exact recipient.

Complete this sign off sheet and return ON DAY OF DECOMMISSIONING by emailing it to: RBSNWBINSTALLS.TIS@ncr.com