BTE Identity Verification Form

Identity Verification Form
Full Name*

First NameLast Name
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Identification proof provided/Type of ID:*
ID number:*
Expiry of ID proof (if applicable):*
I assure that the all the information provided above is true, any false information will lead to imprisonment.
Signature
Please use your phone camera to take pics of your state driver's license and credit card.
Please upload pic of driver license*

Browse Files
front of DL with your picture Cancelof
Please upload pic of credit card (Front)*

Browse Files
Use phone camera to take pic & upload here Cancelof
Please upload pic of credit card (Back)*

Browse Files
Use phone camera to take pic & upload here Cancelof
Should be Empty: