Paragraph 1
I, (name and number) was, on (insert date) and while holding the rank of in NCIS, found to have committed the disciplinary offence(s) mentioned in the first column below with which I had been charged and was punished therefor as mentioned in the second column below, [such punishment(s) being varied on appeal to the punishment(s) mentioned in the third column below]:
| Offence proved | Punishment therefor | Varied on appeal to |
|---|---|---|
1 | 1 | 1 |
2 | 2 | 2 |
3 | 3 | 3 |