RECORDS KEEPING COMPLIANCE FORM

PURSUANT TO 18 U.S.C. § 2257

MelTech, INC.

MODEL IDENTIFYING INFORMATION AND AFFIDAVIT: Model understands that all the information given in this Agreement is being provided to comply with federal law and any false statement will subject Model to both a civil action by Producer as well as criminal prosecution under federal and state law. _________

(Model’s Initials)

a. Legal Name: _________________________ b. Date of Birth: ____________

(Full Current Legal Name: First, Middle, Last) (Month, Day and Year)

Age: _______________

c. Primary identification document must be government issued passport, driver’s license, motor vehicle department ID, or military ID: (Each should be described, including the ID number. Clear, good-quality photocopies of each must be attached to this Form and the photocopies must be signed in ink by Model):

(1) First form of identification: (2) Second form of identification:

____________________________ ___________________________________

ID # ________________________ ID # _______________________________

d. All other names ever used (include previous legal names, stage names, Web handles, maiden or married names, aliases, professional names and nicknames):

(1) ____________________________ (a) _________________________________

(Stage Name for this Production) (All other names)

(2) ____________________________ (b) _________________________________

(Maiden Name if applicable) (All other names)

(3) ____________________________ (c) _________________________________

(Previous legal name, if applicable) (All other names)

e. Phone # ( )_______________________ [Optional]

SWORN STATEMENT: “UNDER 28 U.S.C. §1746 AND THE PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES, I SWEAR THAT THE FOREGOING IS TRUE AND CORRECT AND THAT EACH OF THE IDENTIFICATION DOCUMENTS WHICH I HAVE PROVIDED AND OF WHICH I HAVE SIGNED THE ATTACHED COPY WAS LAWFULLY OBTAINED BY ME AND HAS NOT BEEN FORGED OR ALTERED.”

Signature: _______________________________________ Today’s Date:___________

Model’s Signature (using full legal name)

MODEL MUST ALSO SIGN ATTACHED COPIES!

UNDER 28 U.S.C. §1746 AND THE PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES, I SWEAR THAT I BELIEVE THE FOREGOING IS TRUE AND CORRECT, THAT I HAVE PERSONALLY EXAMINED THE MODEL’S PHOTO IDENTIFICATION AND DATE OF BIRTH, AND THAT I HAVE OBSERVED THE ORIGINALS OF EACH OF THE IDENTIFICATION DOCUMENTS OF WHICH COPIES ARE ATTACHED HERETO AND SIGNED BY THE MODEL.

_____________________________ Today’s Date: _________________

Signature of Primary Witness

_____________________________

Print Name of Witness

Copy of Depiction Attached: Hardcopy/Digital Internet Location/URL: http://www.melissacontest.com