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RECORDS KEEPING COMPLIANCE FORM PURSUANT TO 18 U.S.C. 2257 MODEL IDENTIFYING INFORMATION AND AFFIDAVIT Model understands that all the information given in this Agreement is being provided to comply with federal law and any false statement will subject Model to both a civil action by Producer as well as criminal prosecution under federal and state law. Model s Initials a. Legal Name b. Full Current Legal Name First Middle Last Date of Birth Month Day and Year Age c. Primary identification document must be government issued passport driver s license motor vehicle department ID or military ID Each should be described including the ID number. Clear good quality photocopies of each must be attached to this Form and the photocopies must be signed in ink by Model 1 First form of identification 2 Second form of identification d. Model s Initials a* Legal Name b. Full Current Legal Name First Middle Last Date of Birth Month Day and Year Age c* Primary identification document must be government issued passport driver s license motor vehicle department ID or military ID Each should be described including the ID number. Clear good quality photocopies of each must be attached to this Form and the photocopies must be signed in ink by Model 1 First form of identification 2 Second form of identification d. All other names ever used include previous legal names stage names Web handles maiden or married names aliases professional names and nicknames Stage Name for this Production Maiden Name if applicable Previous legal name if applicable e. Phone Optional SWORN STATEMENT UNDER 28 U*S*C. 1746 AND THE PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES I SWEAR THAT THE FOREGOING IS TRUE 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. Signature Today s Date Model s Signature using full legal name MODEL MUST ALSO SIGN ATTACHED COPIES UNDER 28 U*S*C. 1746 AND THE PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES I SWEAR THAT I BELIEVE THE FOREGOING IS TRUE AND CORRECT THAT I HAVE PERSONALLY EXAMINED THE MODEL S PHOTO IDENTIFICATION AND DATE OF BIRTH AND THAT I HAVE OBSERVED THE ORIGINALS OF EACH OF THE IDENTIFICATION DOCUMENTS OF WHICH COPIES ARE ATTACHED HERETO AND SIGNED BY THE MODEL* Signature of Primary Witness Print Name of Witness Copy of Depiction Attached Hardcopy/Digital Internet Location/URL. Model s Initials a* Legal Name b. Full Current Legal Name First Middle Last Date of Birth Month Day and Year Age c* Primary identification document must be government issued passport driver s license motor vehicle department ID or military ID Each should be described including the ID number. Clear good quality photocopies of each must be attached to this Form and the photocopies must be signed in ink by Model 1 First form of identification 2 Second form of identification d. Clear good quality photocopies of each must be attached to this Form and the photocopies must be signed in ink by Model 1 First form of identification 2 Second form of identification d. All other names ever used include previous legal names stage names Web handles maiden or married names aliases professional names and nicknames Stage Name for this Production Maiden Name if applicable Previous legal name if applicable e.

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