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Identity Verification Form

An option for members joining by internet

For those members who join via the internet (instead of in person at the office), identity verification is a option which may be used to assure other members that you are who you say you are. Although this is not a requirement of membership for members who are unable to come into the office due to distance or other reasons (since we do of course acquire members worldwide via the internet), you may nevertheless want to display the identity verification symbol on your member profile so that it will designate you as a verified member to increase your credibility. This will reassure other members and reduce fears they may have about meeting someone whose identity has not been verified in person at the company office. Persons misrepresenting something about themselves is a frequent complaint from those who have used online services, and although no solution is foolproof, Video Introductions has devised this alternative in an effort to counteract the problem. If you discover someone is not who they purport to be, please notify us immediately via our member complaint process. Deliberate misrepresentation of important facts may be a cause for termination of membership.

In order to have this verification symbol displayed, a member may be verified either:
A) by personal appearance at Video Introductions office providing verification of identity, or
B) by submitting a notary public verification to the Video Introductions office with the information listed below:

(Print this web page from a computer and have a notary public sign it. If you are unable to print this form, you can request that our office send you this form by mail by submitting a preaddressed stamped envelope, or you may write the following form information in ink for the notary to sign):

Legal name of member or prospective member_______________________________________
Birth Date:___________________
(please spell out month, for example, June 1, 1963)
My height is:__________
My weight is:__________

Please check below identifying your gender:
 I am male by birth
 I am female by birth

Please check below identifying your marital status:
 Single (never married)
 Separated - no legal papers filed
 Separated - marital status pending
   Documentation of: Petition for Dissolution of Marriage (divorce filing) papers filed on___________
   Documentation of: Petition for Legal Separation papers filed on_______________
   Documentation of: Petition for Nullity of Marriage (annulment) papers filed on________________
 Divorced, legally separated or annulled.
    The year Final Judgment was granted:_______________.

A notary public verification should have the following (or similar) wording:
Country of ___________________________
State of ___________________________
County (or region) of ___________________________
City of ___________________________
On____________before me,___________________________
          Date                                            Name and Title of Officer (i.e. Jane Doe, Notary Public)
personally appeared________________________________
                                             Name of Signer (member or prospective member's signature)

The above person proved to me on the basis of appearance and satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that they executed the same in their capacity and that by the signature on the instrument is the person who executed the instrument.

Date of signature____________________

Witness my hand and official seal.

Signature of Notary

Notary address_________________________________________
Notary phone number (          )_________________
(Please include area code)

Deliver this document with original signatures to:
Video Introductions
76 Alves Ln. Bay Point CA, California 94565

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