Author Topic: 2257a age verification form  (Read 18037 times)


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2257a age verification form
« on: February 27, 2012, 03:29:30 pm »
2257A Form

 Model identifying information and affidavit: Model understands that all the information give in this agreement is being provided to comply with federal law and any false statement will subject Model to both civil action by Producer as well as criminal prosecution under federal and state law. <<Client Initials>>
A. Legal Name: <<Client Name>>.            B. Date of Birth: <<Date Of Birth>> 
                                                                   Age <<Age>>
C. Primary photo identification document must be US government issued passport,driver's license,motor vehicle department ID,or military ID: (Each should be described, including ID number. Clear, photos or copies of each must be attached to this form.
(1) First form of identification:                  (2)Second from of identification:
       <<ID Type>>.                                          <<2nd ID Type>>
       <<ID Number>>.                                     <<2nd ID #>>
D.  All other names ever used. (include previous legal names,stage names, web handles,maiden or married names,aliases, professional names and nicknames):
(1 ).  <<Stage Name>>.                     (2). <<Married Name>>
(3). <<Previous Name>>.                   (4) <<Professional Name>>
(5).<<Maiden  Name>>                      (6) <<Aliases>>
E.  Phone # <<Client Phone>>
Sworn Statement:  "Under 28 U.S.C. €1746 and the penalties of perjury under the laws of the United States, I swear that the foregoing is true and correct, and that each of the identification documents which I have provided and of which I was photographed with and a copy attached was lawfully obtained by me and has not been forged or altered."
Signature:  <<Client Signature>>.                     Today's Date:<<Event Date>>
Under 28 U.S.C. € 1746  and penalty of perjury under the laws of the United States, I swear that I believe the foregoing is true and correct,that I have personally examined the model's photo identification and date of birth, and that I have observed the photograph of it being held by the model and attached heretofore.
Signature of witness:   <<Client Signature>>      Today's Date <<Event Date>>
Witness Name: <<Witness Name>>

« Last Edit: May 04, 2012, 11:38:58 am by khook02 »