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.

Applicant's Statement (please in readable letters ;-)	Names:	
Date of Birth:	
CAcert account (Email Address):	
CAcert account already created?	[ ] YES [ ] NO
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 Assurer Name: [ ] Ralf Neumann / [ ] ____________________________________________ Sponsor: [ ] ________________________________________________ Photo ID Shown: (ID types, not numbers) [ ] ID-Card / [ ] Passport / [ ] Drivers Licence [ ] ___________________________________________________________________ [ ] ___________________________________________________________________
Location of Face-to-face Meeting: LinuxTag 2005, Karlsruhe , Germany Points Allocated: _______	Date: (2005-03-29) Sign: _________________________	Notes:

LinuxTag 2005	[ / / ]

CAcert Inc. • P.O. Box 75 • Banksia NSW 2216 • Australia • www.CAcert.org

2004-07-11T10:07:29