LinkedIn Member Identity Verification

(for account recovery)

To: LinkedIn Corporation

Date:

I declare UNDER PENALTY OF PERJURY that:

1. My name, title and contact information is as follows:

Name:

Title:

Telephone:
LinkedIn
Email:
LinkedIn
Profile URL:

2. I am unable to access my LinkedIn account at the URL mentioned above due to the following
circumstances:

3. The information I have provided in this notice is accurate.

Signature:

Please include the ticket # here:

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 ACKNOWLEDGMENT

State of ______________________________

County of _____________________________

On _________________________ before me, _____________________________

(insert date) (insert name and title of the officer)
personally appeared ____________________________________________, who proved to me on
the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.

WITNESS my hand and official seal.

Signature ______________________________ (Seal)

Please reply to the email from your LinkedIn customer representative with the completed form attached.

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