HELP CENTER

Gen Mobile Resources

Law Enforcement or Governmental Entity Information Request Policy

Version January 2026

Exhibit A

Emergency Disclosure Form

In an emergency situation involving danger of death or serious physical injury, Gen Mobile may release information to a member of a law enforcement agency or a governmental entity. Please fully complete this form; incomplete forms may lead to a delay.

Name of Requestor:

 

Title and Badge # (if applicable):

 

Name of governmental entity:

 

Address:

 

Telephone #:

 

Email:

 

1.    Why is this an emergency situation that involves immediate danger of death or serious physical injury?

 

 

2.    What information do you have that may help Gen Mobile identify the customer?

 

 

3.    What information are you requesting?

 

 

4.    What is the best way to provide this information to you? (check one)

          ☐ via email    ☐ via telephone call

Indemnification

I acknowledge this request is made solely as a result of immediate danger of death or serious physical injury, and that the information shall not be obtained, shared, or disseminated for any unlawful or harmful purpose. I affirm that I have the legal authority to execute this form and agree to defend, indemnify, and hold Gen Mobile, its parent company, affiliates, subsidiaries, employees, and agents harmless for any and all claims, demands, losses or injury, including reasonable attorneys’ fees brought against Gen Mobile by a third party, including the customer, as a result of Gen Mobile’s compliance with this request.

I declare under penalty of perjury that the foregoing is true and correct.

 

 

______________________________

Requestor’s Signature

                    ____________________________      Date

 

Please send this completed and signed form, on department letterhead, to genmobilelegal@dish.com (with “Emergency Disclosure Form” in the subject line).