Identity Verification Form
Full Name
First Name
Last Name
Permanent Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Identification proof provided/Type of ID
Expiry of ID proof (if applicable)
*
I assure that the all the information provided above is true, any false information will lead to imprisonment.
Signature
I would like to inform that the above mentioned individual approached our agency personally and submitted documents which I believe are genuine as he has proved to be the person mentioned in the id.
Full Name of witness
First Name
Last Name
Agency Name
Address of the agency
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: