18 U.S.C. § 2257 Form
RECORDS KEEPING COMPLIANCE FORM PURSUANT TO 18 U.S.C. § 2257
MODEL IDENTIFYING INFORMATION AND AFFIDAVIT
Model understands that all information given in this Agreement is provided to comply with United States federal law, and any false statement will subject the Model to civil action by the Producer as well as criminal prosecution under federal and state law. [2]
Model Initials: _________
1. PERFORMER / MODEL IDENTIFICATION
Full Legal Name (First, Middle, Last): _________________________________________________
Date of Birth (Month/Day/Year): ____________________ Current Age: _________
Stage Name(s), Web Handles, and/or Aliases Used in Content: _________________________________________________
All Other Names Ever Used (Maiden name, previous legal names, nicknames): _________________________________________________
Current Physical Address: _________________________________________________
Phone Number: ____________________ Email Address: ____________________ [3, 4, 5]
Date of Birth (Month/Day/Year): ____________________ Current Age: _________
Stage Name(s), Web Handles, and/or Aliases Used in Content: _________________________________________________
All Other Names Ever Used (Maiden name, previous legal names, nicknames): _________________________________________________
Current Physical Address: _________________________________________________
Phone Number: ____________________ Email Address: ____________________ [3, 4, 5]
2. PRIMARY IDENTIFICATION DOCUMENTS
Federal law requires at least one government-issued photo ID to prove identity and age, though many producers and hosting platforms require two for verification. Describe the government-issued ID below (e.g., Passport, Driver's License, State ID, Military ID). Clear, good-quality photocopies of the front and back of each ID must be attached to this form, and the photocopies must be signed in ink by the Model. [2, 4, 6, 7]
Identification Document 1:
Type of ID: ____________________ Issuing Authority: ____________________
ID Number: ____________________ Expiration Date: ____________________ [3]
Type of ID: ____________________ Issuing Authority: ____________________
ID Number: ____________________ Expiration Date: ____________________ [3]
Identification Document 2:
Type of ID: ____________________ Issuing Authority: ____________________
ID Number: ____________________ Expiration Date: ____________________
Type of ID: ____________________ Issuing Authority: ____________________
ID Number: ____________________ Expiration Date: ____________________
3. DEPICTION & PRODUCTION DETAILS
Original Date(s) of Production: ____________________
Description of Content / Scene / URL: _________________________________________________
Location of Production: _________________________________________________ [3, 5]
Description of Content / Scene / URL: _________________________________________________
Location of Production: _________________________________________________ [3, 5]
4. MODEL’S SWORN STATEMENT
I, _____________________________________ (print full legal name), hereby swear and affirm under penalty of perjury under the laws of the United States of America that the foregoing information, including my legal name, aliases, and date of birth, is true, accurate, and correct. I certify that I am over the age of 18 and was of legal age at the time this visual content was produced. I acknowledge that a copy of my government-issued identification is attached hereto. [4, 7, 8, 9]
Model’s Signature: _____________________________________ Date: __________________ [4]
5. PRIMARY PRODUCER / WITNESS VERIFICATION
I, _____________________________________ (print full legal name of Producer/Witness), hereby state that I have personally examined the original government-issued photo identification documents listed above, verified that the photograph matches the individual presenting them, and confirmed that the performer is over the legal age of 18. [10]
Producer/Witness Signature: _____________________________________ Date: __________________
Company/Producer Entity Name: _____________________________________
Business Address: _________________________________________________ [4, 11]
Company/Producer Entity Name: _____________________________________
Business Address: _________________________________________________ [4, 11]
Statutory Operational Requirements
To ensure complete legal compliance under the 18 U.S.C. § 2257 framework, the content producer must execute the following actions:
- ID Photocopies: You must physically attach clear, legible copies of the identification used. Both the performer and the primary producer should sign or initial these photocopies in ink to confirm authenticity. [2, 4]
- Record Custody: Records must be organized securely, kept segregated from general business or accounting files, and made readily accessible for inspection by federal authorities. [1]
- Retention Period: These compliance files must be maintained for the duration mandated by federal regulations (typically a minimum of 5 to 7 years after the content is produced or distributed).
