BACKGROUND REGISTRATION FORM

 
All information below will be made available in accordance with Federal Regulation IMBR SEC. 833.5 (d)

As required by the International Marriage Broker Regulation Act Of 2005 [SEC. 833.5 (d) Regulation of International Marriage Broker] Colombian Singles Tours is required to collect the following background information for all Singles Tours participants.
Colombian Singles Tours is also required to conduct an electronic search on the National Sex Offender public registry and state public registry (http://www.nsopr.gov/).
This information and search results will be translated into Spanish and made available to all Colombian women who you communicate with or will be meeting you on a Singles Tour. Your Address, Email address, Phone Number, Birth Date and Passport Number will be kept confidential and will not be released without your written permission.

Please complete, sign and date and return this entire document to ContactUs@ColombianSinglesTours.com.

How many times have you visited the following countires:
Brazil                         Cambodia                  Colombia                   Dominican Republic
Philippians                 Thailand                     Vietnam

If you answer YES to any question below, you are required to provide us detailed documentation, including but not limited to copies of court orders, judgments, convictions and arrest records. You are not required to include marriage certificates, birth certificates or divorce papers.  Additional documents handling may require a translation fee.

□ Yes □ No
Are there now, or have there ever been, at any time, any temporary or permanent civil protection orders, restraining orders, emergency protective orders, or domestic violence orders, issued against you by any court or other governmental authority? 
Provide details here:

                                                                                              .

□ Yes □ No
Have you ever been arrested OR convicted by any Federal, State or Local authority, for homicide, murder, manslaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploitation, incest, child abuse or neglect, torture, trafficking, peonage (compelling persons to perform labor to payoff a debt), holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or stalking?
Provide detail here:

           .

□ Yes □ No
Have you ever been arrested OR convicted by any Federal, State or Local authority, for (a) solely, principally, or incidentally engaging in, prostitution? OR (b) a direct or indirect attempt to procure prostitutes or persons for the purpose of prostitution? OR (c) receiving, in whole or in part, proceeds of prostitution?
Provide details here                .

□ Yes □ No
Have you ever been arrested OR convicted by any Federal, State or Local authority for any offense(s) related to controlled substances or alcohol?
Provide details here:

   .

□ Married □ Single □ Widowed
What is your current marital status? Provide details here:

□ Yes □ No
Have you previously been married?
If "Yes", please fill in the details below for each (Number, How Terminated and Termination Date)
Provide details here:

                .

□ Yes □ No
Have you at any time previously sponsored an alien to whom you were or became engaged, or to whom you were or became married?
Provide details here:

         .

Please list the ages of all of your children, whether biological or adopted, who are under 18 years of age.
1.      2.      3.      4.      5.      6.      7.      8.      9.   10.

Please list all States in the United States, and all countries, in which you have resided since you were 18 years of age:
a)                  b)                  c)                  d)                  e)                  f)    
g)                  h)                   i)                   j)

I certify and attest, under penalty of perjury and false swearing, that I am 18 years of age or older, of sound mind, and that my above BACKGROUND INFORMATION as well as all accompanying documents I have provided, if any, is true, correct and complete, and that should any such information change at any time, I will provide such changes or updates to Colombian Singles Tours.

FURTHERMORE, I authorize Colombian Singles Tours to release and provide this information and any accompanying documentation along with any subsequent changes or updates, in any format, to the lady I choose. I hereby waive any privacy rights from release of this information and I release and hold harmless, and forever discharge, Colombian Singles Tours, its officers, directors, shareholders, employees and agents, from any and all liabilities arising from the release of this information, the accompanying documents, and any changes or updates, and any use thereof.

Signature                     

Date ___/___/___