Identity Verification Form Template

Identity Verification Form
Full Name*
First NameLast Name
Permanent Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Current Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Phone Number
Area CodePhone Number
E-mail
Identification proof provided/Type of ID:
ID number:
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
Clear
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 NameLast Name
Agency Name:
Address of the agency:
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Should be Empty: