I, {name}, under penalty of perjury, with full corporate and individual responsibility, hereby irrevocably, confirm that neither myself, nor anyone else associated with my organization or corporation have been convicted of a felony, either within the United States or anywhere in the world where that crime would be considered equal to a US felony. To the best of my knowledge, I am not, nor are any of my associates within my organization or corporation, considered to be terrorists or on any watch list with the United States Department of Homeland Security.
I, {name}, hereby swear under penalty of perjury, that the information provided herein is accurate and true as of this date: {todaysDate}
Passport Number {number}
Date of Issue {dateOf}
Date of Expiry {date19}
Country of Issuance {issuingAuthority}