CAcert Assurance Programme Identity Verification Form

To the Assurer: The CAcert Assurance Programme (CAP) aims to verify the identities of Internet users through face-to-face witnessing of government issued identity documents. The Applicant asks you to verify to CAcert.org that you have met them and verified their identity against one or more original, trusted, government photo identity documents. If you have ANY doubts or concerns about the Applicant’s identity, DO NOT COMPLETE OR SIGN this form. For more information about the CAcert Assurance Programme, including detailed guides for CAcert Assurers, please visit: www.CAcert.org

As the assurer, you are required to keep the signed document on file for a period of up to 7 years. Should Cacert Inc. have any concerns about a meeting taking place, Cacert Inc. can request proof, in the form of this signed document, to ensure the process is being followed correctly.

CAcert Assurer
Name: ___________________	Sign: ___________________	Date: ___________ Sponsor: ___________________	Sign: ___________________	Date: ___________ Photo ID Shown: (ID types, not numbers. eg Drivers license, Passport) ___________________________________________________________________ ___________________________________________________________________
Location of Face-to-face Meeting: _________________________________________ Points Allocated: _______ Applicant's Statement	Names:	
Date of Birth:	
Email Address:	
I hereby confirm that the information stated above is both true and correct, and request the CAcert Assurer (identified below) to witness my identity in the CAcert Assurance Programme. Applicant’s signature: _______________________ Date (dd/mm/yyyy): _________________ CAcert Inc. • P.O. Box 75 • Banksia NSW 2216 • Australia • www.CAcert.org

CAcert's Root Certificate fingerprints: A6:1B:37:5E:39:0D:9C:36:54:EE:BD:20:31:46:1F:6B and 135C EC36 F49C B8E9 3B1A B270 CD80 8846 76CE 8F33

2004-07-11T10:07:29