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Use to disseminate initial technical information on captured or acquired foreign material and ordnance. Reference: FM 34-54 and FM 34-60.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — MATERIEL CATEGORY_________________________(Category of Materiel the Acquired Items Belong to)

LINE 4 — UNIT ID______________________________________(Identification of the Unit Acquiring the Materiel)

LINE 5 — DAY TIME ACQUIRED_________________________(DTG When the Materiel Was Acquired)

LINE 6 — LOCATION ACQUIRED ________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator Where Acquired)

LINE 7 — CIRCUMSTANCES_____________________________(Brief Description of the Circumstances Surrounding Acquisition of the Materiel)

LINE 8 — CONTACT NAME _____________________________(Name of Reporting Unit POC)

LINE 9 — RANK OR RATE_______________________________(Rank or Rate/Rating of Reporting Unit POC)

LINE 10 — PRIMARY PHONE ____________________________(Primary Telephone Number of Reporting Unit POC)

LINE 11 — PRIMARY FREQUENCY _______________________(Primary Radio Frequency of Reporting Unit Using MHz, Frequency Designator, or Frequency)

LINE 12 — POC LOCATION______________________________(POC Location Using UTM or Six-Digit Grid Coordinate with MGRS Grid Zone Designator)

LINE 13 — SECONDARY PHONE_________________________(Secondary Telephone Number of Reporting Unit POC)

LINE 14 — SECONDARY FREQUENCY____________________(Secondary Radio Frequency of Reporting Unit Using MHz, Frequency Designator, or Frequency)

LINE 15 — OTHER INFORMATION_______________________(Other Additional Information Concerning Unexploded Ordnance Such as Tentative Render Safe Procedures, Other Descriptions)

**Repeat lines 3 through 15 to report multiple materiel acquisitions. Assign sequential line numbers to succeeding iterations; for example, first iteration 3 through 15; second iteration 3a through 15a; third iteration 3b through 15b; and so on.

LINE 16 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 17 — AUTHENTICATION___________________________(Report Authentication)

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