| Licensed to: %LICENSEE% | Erasure provider: %SWTITLEEX% |
| Model: %DEVMODEL% | Rev.: %DEVFIRMWARE% |
| Serial: %DEVSERIAL% | LBA Size: %DEVSIZELBA% (%DEVSIZETXT%) |
| Filler (pattern): %FILLER% | |
| LBA Start: %STARTLBA% | LBA Size: %SIZELBA% (%SIZETXT%) |
| Start time: %TMSTARTTXT% | End time: %TMENDTXT% |
| Status: %REPSTATUS% |
| Name: %OSCOMPNAME% | User: %OSUSERNAME% |
| Report UUID: %REPUUID% |
| Report date: %REPDATETXT% |
| Software version: %SWVERSTXT% |
| I here by state the data erasure process has been carried out in accordance with the given instructions. | |
| Data erasure operator | Supervisor |