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The document is a Human Source Data Report (HUSDAR) that collects detailed personal information about an individual, including their name, contact details, family background, education, employment, and affiliations. It also includes sections for training, activities, and a certification statement regarding the accuracy of the information provided. The report emphasizes confidentiality and the individual's commitment to assist the government in protecting against threats.

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Gerson Lawas
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55 views2 pages

Husdar1 - 1 1

The document is a Human Source Data Report (HUSDAR) that collects detailed personal information about an individual, including their name, contact details, family background, education, employment, and affiliations. It also includes sections for training, activities, and a certification statement regarding the accuracy of the information provided. The report emphasizes confidentiality and the individual's commitment to assist the government in protecting against threats.

Uploaded by

Gerson Lawas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HUMAN SOURCE DATA REPORT (HUSDAR)

_
CONTROL NR DATE OF COMPILATION

(Last Name) (First Name) (Middle Name)

Nickname: Code Name: _ Code Nr:


Address:
(Office):
Tel / CP Nr. _
Date of Birth: Sex: Age: Height: Weight: Build
Place of Birth:
Complexion: Eyes: Hair: _ Mark/Tattoes:
Habit’s/Peculiarities: Weaknesses/Vulnerabilities:
Parent’s: Address:
_ Address:
Brother’s/Sister’s: _ Address:
Address:
Address:
Address:
Address:
Address:

Education: Name of School Location Date Attended

Elementary:
High School:
Colleges:
Others:
Employment/Employer: Address of Employment:
Position/Salary: Religion: Nationality: Status: _
Wife/Husband: _ Nickname/Aliases:
Address of Employment/Employer:
Children’s/Ages:
Hang-out/Lairs:

Name of Contact: Address Occupation REMARKS

Affiliation: Organization Position

_
_

Other Date: Date of Recruitment: Date Dispatch:


Training: Name of Course Place Conducted Period Covered Remarks

_
_
_
_

Past and Present Activities:

Handler:

I certify that all entries are true and correct. I further agree to help the government,
through its designated representative in the collection of information in order to protect our
people from all form of threat. I will not reveal, transmit or convey the nature of my work to
unauthorized persons even after the termination of this agreement. That any violation/breech
of security is sufficient ground to forfeit benefits and protection due me.

_
Full Name & Signature

Date

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