Approved for Release: 2025/06/11 C07177588
SECRET
(When Filled In)
PERSONALITY (201) FILE REQUEST
TO RI/ANALYSIS SECTION DATE ACTION
OPEN AMEND CLOSE
FROM ROOM NO. TELEPHONE
INSTRUCTIONS: Form must be typed or printed in block letters.
SECTION I: List 201 number, name and identifying data in the spaces provided. All known aliases and variants (including maiden name, if applicable) must be listed. If the identifying data varies with the alias used, a separate form must be used. Write UNKNOWN for items you are unable to complete.
SECTION II: List cryptonym or pseudonym, if assigned. If true name is sensitive, obtain 201 number from 201 Control Desk and complete Section I and Section III. On a separate form, enter the 201 number and complete Section II and Section III. Submit each form separately.
SECTION III: To be completed in all cases.
SECTION I
SENSITIVE 201 NO. 1. SOURCE DOCUMENT
NONSENSITIVE
NAME (Last) (First) (Middle) (Title) SEX 3.
TYPE NAME 2. NAME VARIANT
PHOTO 4. BIRTH DATE 5. COUNTRY OF BIRTH 6. CITY OR TOWN OF BIRTH 7. OTHER IDENTIFICATION 8.
YES NO D M Y
OCCUPATION/POSITION OCC/POS. CODE 9.
SECTION II
CRYPTONYM PSEUDONYM
SECTION III
COUNTRY OF RESIDENCE 10. ACTION DESK 11. SECOND COUNTRY INTEREST 12. THIRD COUNTRY INTEREST 12a.
COMMENTS:
RI COPY
PERMANENT CHARGE RESTRICTED FILE SIGNATURE
YES NO YES NO
SECRET
CIA INTERNAL USE ONLY
(38)
Approved for Release: 2025/06/11 C07177588