RECORDSKEEPINGCOMPLIANCEFORMPURSUANTTO18U.S.C.

2257
MODELIDENTIFYINGINFORMATIONANDAFFIDAVIT:Modelunderstandsthatalltheinformationgivenin
thisAgreementisbeingprovidedtocomplywithfederallawandanyfalsestatementwillsubjectModeltobothacivil
actionbyProduceraswellascriminalprosecutionunderfederalandstatelaw. _______
(ModelsInitials)
a.

LegalName:____________________________
(FullCurrentLegalNameFirst,Middle,Last)

b.

DateofBirth:____________
(Month,Day,Year)

Age:_____

c.
Primaryidentificationdocumentmustbegovernmentissuedpassport,driverslicense,motorvehicledepartment
ID,ormilitaryID.(Eachshouldbedescribed,includingtheIDnumber.Clear,goodqualityphotocopiesofeachmustbe
attachedtothisFormandthephotocopiesmustbesignedininkbyModel.)
(1)Firstformofidentification

(2)Secondformofidentification

____________________________________

____________________________________

ID#________________________________

ID#________________________________

d.
Allothernamespreviouslyused(includepreviouslegalnames,stagenames,Webhandles,maidenormarried
names,aliases,professionalnamesandnicknames).

e.

(1)_________________________________
(Stagenameforthisproduction)

(a)_________________________________
(Allothernames)

(2)_________________________________
(Maidennameifapplicable)

(b)_________________________________
(Allothernames)

(3)_________________________________
(Previouslegalnameifapplicable)

(c)_________________________________
(Allothernames)

Phone#()__________________(optional)

SWORNSTATEMENT:UNDER28U.S.C.1746ANDTHEPENALTIESOFPERJURYUNDERTHELAWS
OFTHEUNITEDSTATES,ISWEARTHATTHEFOREGOINGISTRUEANDCORRECTANDTHATEACH
OFTHEIDENTIFICATIONDOCUMENTSWHICHIHAVEPROVIDEDANDOFWHICHIHAVESIGNED
THEATTACHEDCOPYWASLAWFULLYOBTAINEDBYMEANDHASNOTBEENFORGEDOR
ALTERED.
Signature:

_______________________________
(ModelsSignature)

TodaysDate:___________

SWORNSTATEMENT:UNDER28U.S.C.1746ANDTHEPENALTIESOFPERJURYUNDERTHELAWS
OFTHEUNITEDSTATES,ISWEARTHATIBELIEVETHEFOREGOINGISTRUEANDCORRECT,THAT
IHAVEPERSONALLYEXAMINEDTHEMODELSPHOTOIDENTIFICATIONANDDATEOFBIRTH,AND
THATIHAVEOBSERVEDTHEORIGINALSOFEACHOFTHEIDENTIFICATIONDOCUMENTSOF
WHICHCOPIESAREATTACHEDHERETOANDSIGNEDBYTHEMODEL.
Signature:

_______________________________
(SignatureofPrimaryWitness)

TodaysDate:___________

_______________________________
CopyofDepictionAttached:

Hardcopy/Digital

InternetLocation/URL______________________

(PrintNameofPrimaryWitness)

CopyofDepictionAttached:

Hardcopy/Digital

InternetLocation/URL______________________