Identity Verification Form Template

Date: [Date]
Purpose of Verification: ☐ Customer onboarding ☐ Account access ☐ Contract signing ☐ Compliance ☐ Other: [Purpose]

1. Person Information

1.1 Full Legal Name: [Name]
1.2 Date of Birth: [MM/DD/YYYY]
1.3 Phone: [Phone]
1.4 Email: [Email]
1.5 Current Address: [Address]
1.6 Previous Address (Optional): [Address]
1.7 Company/Organization (Optional): [Company]
1.8 Role/Title (Optional): [Role]

2. Identification Document(s) Reviewed

2.1 Primary ID Type: ☐ Passport ☐ Driver’s license ☐ National ID ☐ Residence permit ☐ Other: [Type]
2.2 Issuing Country/State: [Issuer]
2.3 ID Number: [ID number]
2.4 Issue Date (Optional): [Date]
2.5 Expiration Date: [Date]
2.6 Name on ID Matches Person: ☐ Yes ☐ No (explain): [Notes]
2.7 Photo Matches Person: ☐ Yes ☐ No (explain): [Notes]

2.8 Secondary Document (Optional): ☐ Utility bill ☐ Bank statement ☐ Tax document ☐ Other: [Type]
2.9 Document Reference/Number (Optional): [Number]
2.10 Date of Document: [Date]
2.11 Address Matches: ☐ Yes ☐ No (explain): [Notes]

3. Verification Method

3.1 Method Used (Check all that apply):
☐ In-person review of original document(s)
☐ Remote video verification
☐ Database/credit bureau check
☐ Third-party verification provider: [Provider name]
☐ Other: [Method]

3.2 Verification Notes. [Notes about checks performed, mismatches, resolution steps]

4. Consent and Privacy

4.1 Consent. The individual confirms the information provided is accurate and authorizes the verifier to review the documents listed above for identity verification purposes.
4.2 Privacy. Identity information will be used only for the stated purpose and stored securely, subject to applicable law and internal policy.

5. Verifier Information

5.1 Verified By: [Verifier name]
5.2 Company/Department: [Company/Department]
5.3 Method of Review: ☐ In-person ☐ Remote ☐ Other: [Method]
5.4 Result: ☐ Verified ☐ Not verified ☐ Pending additional information
5.5 Additional Notes (Optional): [Notes]

Signatures

Individual: [Full Name]
Date: [Date]
Signature: ___________________________

Verifier: [Verifier Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________