Kafka 4 | Erica Roozendaal

Here is one last chance for you to correct any errors. Structure your text as follows: First, state the question, then give your answer. Please note: If the question is not phrased exactly as we have written it, the system may not recognize it.

Do you consider yourself to be the person you identified in Question 1?

Yes No I don't remember

Can you prove this?

Have you used a different name in the past without notifying us?

Yes No I don't remember

If you did not answer “yes” to the questions above, you do not meet the eligibility requirements for this form.

I hereby declare that I have answered the above questions truthfully.