Identity & Intent Verification Request - Form HVD-7(b)

Ref. No.: HVD-7B-2026 | Revision 14 | Supersedes Form HVD-6(c)

NOTICE: This portal is monitored. Incomplete submissions will be logged. All fields are mandatory.

Section I - Applicant Identity

1a. Legal Last Name (as it appears on government-issued identification) *

1b. Legal First Name *

1c. Middle Initial (if applicable)

1d. Legal Name Confirmation - Re-enter full name in the boxes below, one character per cell * (Ref. 1a & 1b)

Enter characters left to right. Use one box per letter. Omit punctuation. Surname first, given name second, separated by space cell.

Section II - Temporal Attestation

2a. Current Calendar Date *

Do not use a date picker. Manual entry only.

2b. Current Local Time at Moment of Submission *

Do not use a time picker. Manual entry only.

2c. Current Time Zone Designation *

2d. Confirm that the above date and time are accurate to the best of your knowledge *

I attest that the date and time entered above are accurate. I am uncertain of the exact time. I decline to confirm.

Section III - Statement of Purpose

3a. Reason for Requesting Access to This Protected Resource *

Minimum 20 characters. Maximum 500 characters.

3b. Statement of Qualifications - Explain why you should be granted CAPTCHA clearance *

Minimum 30 characters. Maximum 500 characters.

3c. Nature of Access Request *

3d. Urgency Level of This Request *

Level 5 of 10 - Moderate

1 = Non-urgent. 10 = Critically time-sensitive. Urgency does not affect processing order.

Section IV - Compliance Declarations

I confirm that the information provided in this form is accurate, complete, and entered voluntarily without coercion by any third party, whether human or automated.

I acknowledge that I am the individual identified in Section I and that I bear sole responsibility for all entries made herein.

I understand that this submission will be reviewed by the Human Verification Department and that no automated decision shall be made without human oversight, subject to departmental capacity.

I have read and understood all instructions on this form, including sub-notes, reference codes, and supplementary guidance issued by the Department.

I consent to this submission being retained for a minimum of seven (7) years in accordance with standard record-keeping obligations.

I acknowledge that approval of this request does not constitute a right of access and may be revoked at any time without prior notice.

Section V - Final Attestation

5a. Enter the phrase "I CERTIFY THE ABOVE IS TRUE" in the field below, exactly as shown *

All capitals. Exact match required.

5b. Re-enter today's date for final attestation purposes *

Must match Section 2a entry.

By completing and submitting this form, the applicant irrevocably and unconditionally waives all rights, claims, and reasonable expectations of privacy with respect to any and all information entered herein, including but not limited to personal identifiers, temporal data, and stated intentions. The Human Verification Department and its designated third-party processing partners reserve the right to retain, reproduce, transfer, license, aggregate, and commercially distribute submitted data in perpetuity, across all jurisdictions, without further notice, compensation, or consent. Submission constitutes full and binding acceptance of these terms.

Submission does not guarantee verification.

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