Identity Verification Form PDF Details

Identity verification is an important part of our lives. Whether we are opening a new bank account, applying for a job, or renting a car, we are often required to provide some form of identification. But what happens when your identity is stolen? That's where identity verification comes in. By completing an identity verification form, you can help protect yourself from identify theft and other crimes.

Below is the information about the form you were looking for to complete. It can tell you the span of time you'll need to fill out identity verification form, exactly what fields you will need to fill in, and so forth.

QuestionAnswer
Form NameIdentity Verification Form
Form Length2 pages
Fillable?Yes
Fillable fields21
Avg. time to fill out4 min 42 sec
Other namesconfirmation of identity form, identity verification letter sample, identity verification form vitalchek, identity verification form download

Form Preview Example

Identity Verification Form

Upon request by PSNC Energy, this form must be completed to validate an individual’s identity in connection with establishing or maintaining a utility account with PSNC Energy.

Section I

I, _______________________________, the undersigned, do hereby state and declare the following:

PRINTED NAME

This Identity Verification Form concerns utility service at the following service location:

Address: _____________________________________________________________________________

City: ___________________________ State: ____ ZIP: _______ Contact Phone #: _____________

I understand that knowingly making any false or fraudulent statement or representation may constitute a violation of federal, state, or local criminal statutes, and may result in imposition of a fine or imprisonment or both.

Applicant Signature: __________________________________________ Date: __________________

Section II (To be completed by the notary)

State: _________________________________________ County: ________________________________

I do hereby certify that __________________________________ personally appeared before me this

day and is known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained.

WITNESS my hand and official seal this________ day of ______________ in the year 20 _____ .

My commission expires: __________________________

_____________________________________________

(Notary Printed Name)

_____________________________________________

(Notary Signature)

This Identity Verification Form was completed by a notary at the following:

Notary Address: _______________________________________________________________________

City: _________________________________________ State: ___________ Zip: _____________

Identity Verification Form Instructions

Instructions for Applicant:

In order to receive service from PSNC Energy, this Identity Verification Form must be completed. Service will not be provided until the completed form is received by PSNC Energy.

1.Complete all fields in Section I.

2.Present yourself to a licensed notary.

3.Have the licensed notary complete Section II (Request an ink notary stamp so document can be

faxed). The name and address should be the location at which the notary can be contacted (For exampleXYZ Bank, 123 Main Street, Raleigh, NC 28212 or Notary’s home address).

4.Fax the completed and notarized Identity Verification Form to PSNC Energy at 17048103122. Once received, PSNC Energy will contact you at the Contact Number provided in Section I on the Identity Verification Form to complete the application process.

Note: The original notarized Identity Verification Form with all fields completed must be received at the address listed below within ten business days or the account is subject to disconnection. We recommend you keep a copy for your records.

5.Mail this completed original form to:

PSNC Energy Receivables Management

PO Box 935

Lowell, NC 28098

6. If you have questions, please contact PSNC Energy at 18777762427.

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