International Marriage Broker Regulation Act of 2005

Client Background Information

SPECIAL NOTE: Under new federal legislation effective March 06, 2006, ASL Corp is mandated to collect the following background information from each American citizen or resident who wishes to use our services. We will also be required to conduct an electronic search on the National Sex Offender public registry and state public registry (http://www.nsopr.gov/). This information and the search results will be made available to all ladies interested in meeting American men. Please complete, sign & date the questionnaire below and return it to us with any purchases or tour payments.

If you answer “YES” to any of the questions below, please provide a Detailed Statement of Explanation and Information, or alternatively any Necessary Optional Documentation. Additional documents may require a translation fee. Add additional pages to any questions as necessary.

No	Yes	(1) Have there been any temporary or permanent civil protection orders or restraining orders issued against you. If you answer “YES” please provide details.
No	Yes	(2) Have you had any Federal, State, or local arrest or convictions for homicide, murder, manslaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploitation, incest, child abuse or neglect, torture, trafficking, peonage, holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or stalking. If you answer “YES” please provide details.
No	Yes	(3) Have you had any Federal, State, or local arrest or convictions for (I) solely, principally, or incidentally engaging in prostitution; (II) a direct or indirect attempt to procure prostitutes or persons for the purpose of prostitution; or (III) receiving, in whole or in part, of the proceeds of prostitution. If you answer “YES” please provide details.
No	Yes	(4) Have you had any Federal, State, or local arrest or convictions for offenses related to controlled substances or alcohol. If you answer “YES” please provide details.
(5) Martial History
No	Yes	a. Are you currently married
No	Yes	b. Where you previously married
c. If you were previously married, how many times

d. How were previous marriages terminated (i.e. divorce, death) and date of termination		Previous Marriage Date Terminated Previous Marriage Date Terminated Previous Marriage Date Terminated Previous Marriage Date Terminated Previous Marriage Date Terminated

No	Yes	(6) Have you previously sponsored an alien to whom you were engaged or married. If so, list details.
		(7) List the ages of your children who are under the age of 18.
		(8) List all States, Counties, Cities, Zip Codes and Countries in which you have resided since you were 18 years of age and the dates you lived in each place.

I Certify and Attest, that my above Client Background Information Is True and Complete. I also give my permission to ASL Corp to release and provide this information in any format to all interested foreign ladies. I have provided all necessary additional truthful documentation to all questions answered ‘Yes’ above. I hereby waive any privacy rights from release of this information. I also hereby release and hold harmless and forever discharge ASL Corp. from any and all liabilities arising from my release of this information and any use of it.

Signature ____________________________________________ Date_____/______/______

Print Name: ___________________________________________ D.O.B._____/______/______

Address __________________________ City_______________ State_____ Zip Code________

Telephone: (______)_____________-____________ Email:______________________________

Send this completed form and all supporting documentation by postal mail to: ASL Corp. P.O. Box 1555, Blue Hill, ME 04614-1555, or Fax it to us at: (201) 603-1133 or E-mail it to us at: service@aslcorp.us

For Internal Use Only, (Client does not complete) Date _____/______/______
Search By:______________________________ Result:___________________________________
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