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 resassure
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.
Debliberate 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)
Widowed
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 annuled.
The year Final Judgement 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
4701-B Clayton Rd.
Concord, CA 94521
(925)676-2399
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