Verification of Identity Form

VERIFICATION OF IDENTITY FORM

Parties and Recitals

Client Name:

Verifier Organization:

WHEREAS, Client seeks formal verification of identity for the purpose of establishing identity for business, regulatory, or contractual relationships; and

WHEREAS, Verifier is duly authorized and qualified to perform identity verification services in accordance with applicable standards and will conduct verification in reliance upon documents and processes acceptable to Verifier; and

NOW, THEREFORE, in consideration of the mutual covenants set forth below, the parties agree as follows:

Identity Details

Documents Presented

The following original or certified documents were presented and inspected by Verifier. Check all that apply and provide identifying details below.

Passport    Driver's License    State ID Card    Other

Scope of Work

Verification Method:    In-person inspection    Remote video verification    Database or watchlist checks

Payment Terms

Fee Amount:    Payment Schedule:

Late Fee: A late fee of will apply to unpaid invoices not received within days of invoicing. All fees are non-refundable except as otherwise required by law.

Term and Termination

Term Start Date:    Term End Date:

Either party may terminate this Agreement for cause upon written notice describing the breach. For convenience, either party may terminate upon days' written notice. Termination does not relieve the client of obligation to pay fees for services performed prior to termination.

Confidentiality

Verifier shall treat all personally identifiable information and documentary evidence provided by Client as confidential and shall not disclose such information except (a) as required by law or regulation, (b) to its agents and contractors performing obligations under this Agreement who are bound by confidentiality obligations no less protective than those herein, or (c) with the prior written consent of Client. Verifier will implement reasonable administrative, technical and physical safeguards to protect personal information against unauthorized disclosure, access or misuse.

Certifications and Representations

Client represents that the information and documentation provided to Verifier is true, correct and complete to the best of Client's knowledge. Client acknowledges that Verifier's verification is based on the documents and methods described in the Scope of Work and that Verifier has no liability for false or forged documents not reasonably detectable by the verification methods employed.

Certification: I certify under penalty of perjury under the laws of the governing jurisdiction that the information provided on this form is true and correct and that the identification documents presented are genuine to the best of my knowledge.

Governing Law; Entire Agreement

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles.

Entire Agreement: This document, together with any attachments or exhibits expressly incorporated herein, constitutes the entire agreement between the parties regarding the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written.

Additional Information

Record Retention: Copies or records of identification documents and verification results will be retained by Verifier for a minimum of unless otherwise required by law.

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