Records Keeping Compliance Form
Pursuant TO 18 U.S.C 2257
 

* Required Fields  
Models Identifying Information And Affidavit: Models understands that all the information given in this Agreement is being provided to comply with federal law and any false statement will be subject Model to both civil action by producers as well as criminal prosecution under federal and state law.* (Initial)

A. Legal Name:  *
B. Date of Birth: * Age: *

C. THE AFORMENTIONED INFORMATION WAS ACQUIRED BY THE MANDATORY EXAMINATION OF THE FOLLOWING Two forms of identification, including at least one government issued photo identification document SUCH AS A VALID DRIVER’S LICENSE OR A PASSPORT: (EACH SHOULD BE Described, including the ID number.
(1) First form of identification: (2) Second form of identification:
* *
I.D. # I.D. #
* *
 
D. All other names ever used (include all stage names, web handles, maiden names,
ALIASES, PROFESSIONAL NAMES and nick names):

*
(Stage name for this production)
(All other names)
(Maiden name if applicable)
(All other names)
(Previous legal name, if applicable)
(All other names)

SWORN STATEMENT: “UNDER 28 U.S.C. 1746 AND THE PENALITIES OF PERJURY
UNDER THE LAWS OF THE UNITED STATES, I SWEAR THAT THE FOREGOING IS TRU AND CORRECT AND THAT EACH OF THE IDENTIFICATION DOCUMENTS WHICH I HAVE PROVIDED AND OF WHICH I HAVE SIGNED THE ATTACHED COPY WAS LAWFULLY OBTAINED BY ME AND HAS NOT BEEN FORGED OR ALTERED.”

* ADDRESS:
   APPARTMENT:
* CITY:
* STATE:
* ZIP CODE:
* TELEPHONE NUMBER:
Signature:
Sign in person (field not required)

 


18 U.S.C. 2257 Record-Keeping Requirements Compliance statement
All models on this site were at least 18 years of age at the time of filming.
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