CISO Authorization Form

CISO Authorization Form

This CISO Authorization Form (the Authorization) is made and entered into as of by and between Organization Name: , an entity with principal place of business at , and Chief Information Security Officer (CISO): , Title: , Email: .

RECITALS

WHEREAS, Organization requires a designated security authority to make binding decisions concerning information security governance, risk acceptance, vendor security assessments, emergency access, and execution of security-related contractual provisions; and

WHEREAS, the CISO is employed by or engaged with Organization and possesses the expertise and delegated authority to act on behalf of Organization for the matters described herein; and

WHEREAS, Organization desires to document the scope, limits, reporting obligations, and duration of the CISO's authority in order to ensure enforceable internal controls and third-party reliance where applicable.

NOW, THEREFORE

In consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

1.1 "Authorized Actions" means those actions expressly granted to the CISO under Section 2. "Risk Acceptance" means formal written acceptance of residual security risks as permitted under Organization policy.

2. GRANT OF AUTHORITY

2.1 Organization hereby delegates to the CISO the authority to perform the following Authorized Actions, subject to any limits set forth below and applicable Organization policies:

Scope of Authorization (check all that apply): Authorize third-party vendor security assessments and grant vendor access consistent with approved controls Execute formal risk acceptance for residual risks within approved monetary or impact thresholds Authorize emergency privileged access or temporary system overrides to restore critical services Sign security addenda, representations, and standard security attachments to commercial agreements Represent Organization in security-related negotiations with third parties

2.2 Monetary or impact threshold for risk acceptance and signing authority, if any: $

3. LIMITATIONS AND CONDITIONS

3.1 The CISO shall exercise granted authority in accordance with Organization policies, industry-standard security practices, and applicable law. The CISO shall not subordinate regulatory compliance obligations to operational expediency.

3.2 Any acceptance of material residual risk that exceeds the monetary limit set forth above, or that materially affects Organization's financial reporting, legal exposure, or customer contracts, requires prior written approval of the Board or an authorized executive officer.

4. DELEGATION

The CISO may delegate specific tasks to qualified personnel. Any delegation must be documented in writing, identify the delegate, and specify the scope and duration of the delegation. Delegation does not relieve the CISO of ultimate responsibility for decisions made under this Authorization.

5. TERM AND TERMINATION

5.1 This Authorization is effective from through , unless earlier revoked in writing by Organization.

5.2 Organization may terminate or amend this Authorization at any time upon written notice to the CISO. Termination shall not affect obligations incurred prior to the effective date of termination.

6. REPORTING AND RECORDS

6.1 The CISO shall maintain written records of all Authorizations granted, delegations made, risk acceptance decisions, and executed security attachments. Such records shall be provided to Organization leadership upon request.

6.2 Reporting frequency: . Primary report recipient: .

7. CONFIDENTIALITY

The CISO shall treat all non-public information obtained in connection with authorized duties as confidential and shall not disclose such information except as required by law or as authorized by Organization policy. The CISO's confidentiality obligations survive termination of this Authorization.

8. INDEMNIFICATION

Organization shall indemnify and hold harmless the CISO for actions taken in good faith within the scope of this Authorization, provided such actions were reasonable and in compliance with Organization policy and applicable law. This indemnity does not cover willful misconduct or gross negligence.

9. NOTICES

All notices required or permitted under this Authorization shall be in writing and delivered to the addresses below. Notice to Organization:

10. AMENDMENTS; WAIVER; COUNTERPARTS

This Authorization may be amended only by a written instrument signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party against whom enforcement is sought. This Authorization may be executed in counterparts, each of which shall be an original and together constitute one instrument.

11. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

Governing Law: The parties agree that this Authorization shall be governed by and construed in accordance with the laws of , without regard to conflicts of law principles.

If any provision of this Authorization is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect. This Authorization constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior agreements and understandings.

12. ACKNOWLEDGMENT

The undersigned CISO acknowledges receipt of this Authorization, accepts the delegated responsibilities, and warrants that the information provided is true and accurate to the best of the undersigned's knowledge.

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