Legal Identity Verification Form

LEGAL IDENTITY VERIFICATION FORM

This Legal Identity Verification Form (the "Form") is entered into as of the date of final signature below by and between Requesting Party: , an entity of type Individual Corporation LLC Partnership Other , with principal place of business at ; and Verified Individual: , date of birth: , residing at .

RECITALS

WHEREAS, the Requesting Party requires verification of the identity of the Verified Individual as a condition to authorizing access to certain services, records, or transactions; and

WHEREAS, the Verified Individual desires to provide truthful identification information and to authorize reasonable verification procedures under the terms set forth in this Form; and

WHEREAS, both parties wish to set forth their respective rights, obligations, and procedures regarding the collection, use, retention, and disclosure of identifying information;

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form: "Personally Identifiable Information" means name, date of birth, government‑issued identification numbers, photographic identification, address, and any records that can, alone or in combination, be used to distinguish or trace an individual's identity. "Verification Procedures" means the steps described in Section 2 used to confirm the identity of the Verified Individual.

2. VERIFICATION PROCEDURES

The Verified Individual shall present one or more government- or state-issued photo identifications and, if required by the Requesting Party, secondary corroborating documents. The Requesting Party shall inspect the presented identification for authenticity, compare identifying data to the Verified Individual, and record the following details in the fields below. The Requesting Party may, at its discretion and subject to applicable law, use electronic identity confirmation services to corroborate presented information.

3. IDENTIFICATION DOCUMENTS

Documents presented (check all that apply):
Driver's License Passport State ID Card Military ID Other (describe below)

4. REPRESENTATIONS AND WARRANTIES

The Verified Individual represents and warrants that all information provided in this Form and any documents submitted for verification are true, complete, and accurate to the best of the Verified Individual's knowledge, that the presented documents are genuine and not altered, and that the Verified Individual is the person identified in those documents. The Requesting Party represents and warrants that it will use the information collected solely for the authorized purposes described in this Form and in accordance with applicable law.

5. CONSENT TO USE AND DISCLOSURE

The Verified Individual expressly authorizes the Requesting Party to collect, store, process, and, where necessary, disclose the Personally Identifiable Information provided for the limited purpose of identity verification and for any ancillary compliance activities. Any further disclosure beyond the verification purpose requires separate written consent unless otherwise compelled by law.

6. RECORDS RETENTION AND DESTRUCTION

The Requesting Party shall retain copies of verification records only for the period reasonably necessary to satisfy legal, regulatory, or contractual obligations, after which such records shall be securely destroyed or anonymized. Retention periods and destruction methods shall be documented in the Requesting Party's records retention policy.

7. LIABILITY; INDEMNIFICATION

Each party shall be responsible for its own acts and omissions in performing obligations under this Form. The Verified Individual agrees to indemnify and hold harmless the Requesting Party from claims arising from the Verified Individual's intentional misrepresentation or fraudulent presentation of identity documents. The Requesting Party's liability for any claim arising from its gross negligence or willful misconduct shall not be limited by this paragraph.

8. CONFIDENTIALITY

Except as required by law, both parties shall maintain as confidential any non‑public information received in connection with this Form and shall use such information solely for the purposes described herein. Confidential information may be disclosed to affiliates, advisors, or processors under written obligations of confidentiality consistent with this Section.

9. NOTICES

All notices or communications required or permitted under this Form shall be in writing and delivered to the addresses set forth below or to such other address as a party may designate by notice in accordance with this Section.

10. AMENDMENTS; WAIVER; COUNTERPARTS

No amendment or waiver of any provision of this Form shall be effective unless in a writing signed by both parties. No failure or delay in exercising any right shall operate as a waiver. This Form may be executed in counterparts, each of which shall constitute an original and all of which together shall constitute one instrument.

11. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This Form shall be governed by and construed in accordance with the laws of the jurisdiction specified by the Requesting Party at , without regard to conflict of laws principles. If any provision of this Form is held invalid or unenforceable, the remainder of this Form shall remain in full force and effect. This Form constitutes the entire agreement between the parties with respect to identity verification and supersedes all prior oral or written understandings.

12. RECORD OF VERIFICATION

Verification performed by (name and title):

Verification completed on: by organization:

CERTIFICATION

The Verified Individual certifies that the information and documents provided are genuine and that the Verified Individual is the person identified therein. The Verified Individual acknowledges that knowingly providing false information or false documents may subject the person to civil and criminal penalties under applicable law.

Sign Now