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<link rel="stylesheet" type="text/css" href="CSS/main.css" /><title>Schedule Enrollments</title>

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$expected = array ('name','state','county','address','birthdate','birthplace','mom','dad','birthaddress','nickname','social');
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$pdf->AddPage();
$pdf->SetFont('Times','B',16);
$pdf->Cell(0,10,'AFFIDAVIT OF IDNETITY',0,0,'C');
$pdf->Ln(10);
$pdf->SetFont('Times','',12);
$pdf->Cell(0,10,'STATE OF '.$state.' COUNTY OF '.$county,0,0,'C');
$pdf->Ln(10);
$pdf->Cell(0,10,'I, '.$name.' ,being duly sworn, and under penalties of perjury, state that:');
$pdf->Ln(5);
$pdf->Cell(0,10,'I reside at '.$address);
$pdf->Ln(5);
$pdf->Cell(0,10,'I was born on the date '.$birthdate.' at '.$birthplace);
$pdf->Ln(5);
$pdf->Cell(0,10,'The name given to me at my birth was '.$name);
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$pdf->Cell(0,10,'The names of my parents at the time of my birth were '.$mom.' and '.$dad);
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$pdf->Cell(0,10,'My address at the time of my birth was '.$birthaddress);
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$pdf->Cell(0,10,'I am also known by others as '.$nickname);
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$pdf->Cell(0,10,'My soial security number is '.$social);
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$pdf->Ln(5);
$pdf->Cell(0,10,'The biometric information which is obtained today by __________________ and which further identifies me is');
$pdf->Ln(5);
$pdf->Cell(0,10,'to be made part of this record');
$pdf->Ln(5);
$pdf->Cell(0,10,'I am responsible for determining under what circumstances the information in this record is to be disclosed, and to');
$pdf->Ln(5);
$pdf->Cell(0,10,'whom it will be disclosed, as specifed in my Disclosure Practice Statement');
$pdf->Ln(15);
$pdf->Cell(0,10,'_______________________________________ ______________');
$pdf->Ln(5);
$pdf->Cell(0,10,'Signature Date');
$pdf->Ln(15);
$pdf->SetFont('Times','B',16);
$pdf->Cell(0,10,'Jurat',0,0,'C');
$pdf->SetFont('Times','',12);
$pdf->Ln(10);
$pdf->Cell(0,10,'Before me, a duly commissioned Notary Public within and for the '.$state.' and '.$county.' aforsaid, personally appeared');
$pdf->Ln(5);
$pdf->Cell(0,10,$name.' who, after being dulysworn as required by law, deposes and says the foregoing and');
$pdf->Ln(5);
$pdf->Cell(80,10,'that this affidavit is made for the puropose of establishing [his/her] indentiy for purposes to be determined by');
$pdf->Ln(5);
$pdf->Cell(0,10,'[himself/herself]');
$pdf->Ln(10);
$pdf->Cell(0,10,'Subsribed and sworn to before me this ____ day of ________, 20___ when my commission expires');
$pdf->Ln(15);
$pdf->Cell(0,10,'_________________________');
$pdf->Ln(15);
$pdf->Cell(0,10,'NOTARY PUBLIC');
$pdf->Ln(5);
$pdf->Cell(0,10,'Copyright 2001-2008 Village Inc. All rights reserved.');
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</head>
<body>
<h1>Establishing a Reliable Identity</h1>
<h2><br />
</h2>
<div style="text-align: center; font-style: italic; font-weight: bold;"><big><big><big>...and
a privacy fortress&nbsp;</big></big></big></div>
<h2></h2>
<h2><span style="font-weight: normal;">Welcome to
the&nbsp;Reliable Identities enrollment preparation page. While
your enrollment may have been requested by an employer or insurer or
other organization whose network or digital assets need protection, the
first thing we'll protect is your own information.&nbsp;<br />
<br />
An identity is composed of many elements, two of which are - or should
be - used when you
log on to a network or Web site:
<ol style="list-style-type: decimal;">
<li>Assertion of Identity
</li>
<li>Attestation of Identity
</li>
</ol>
You <i style="font-weight: bold;">assert</i><span style="font-weight: bold;"> </span>your identity when
you type a username (or an OpenID or an I-Name, etc.)
<br />
<br />
An identity certification authority then <span style="font-weight: bold;">attests</span>
that you're telling the truth about your identity by means of an
Identity Certificate. <a href="http://pkiuniversity.com">Click
here to learn how digital certificates work.
</a><br />
<br />
In order for a certification authority to attest to your identity, it
must know that the enrollment was performed properly. Our Identity
Certificates are issued according to the
principles of the Quiet Enjoyment Infrastructure, part of which is the
My
Own Information infrastructure. Think of MOI as a fortress that you own
- a fortress where you keep information that identifies you. MOI lets
you to put
information about yourself into a form that enables you to claim
ownership of it, according to copyright and trade secret law. <span style="font-weight: bold;">Your
information becomes your intellectual property</span> - and if
you think about
it, isn't that the way it should be?<br />
<br />
Better yet, MOI lets you disclose to a relying party only what it needs
to
know about you, and nothing more. After all, the relying party (a store
or insurance company or an employer for example) doesn't need to know
all your enrollment information. They only need to know that you're the
person you said you were.<br />
<br />
<big style="font-weight: bold;">Turning the Tables on DRM<span style="text-decoration: underline;"></span></big></span></h2>
<h2><span style="font-weight: normal;">The
heart of
your MOI is your Personal&nbsp;Nondisclosure Agreement, which
grants
permission to specific relying parties to know
specific&nbsp;information about you for a specific purpose. Since
information about you remains your intellectual property, the relying
party is prohibited
from sharing it with anyone unless you specifically
authorize it. That's
not a vague promise offered by some privacy statement;&nbsp;it's a
legal agreement from you that any relying party&nbsp; must sign and
uphold. If for instance the recording industry wants information about
you, they must agree to your own Digital Rights Management system.<br />
<br />
Your MOI serves as the basis of&nbsp;at least two certificates. The
first one, your Foundational Certificate&nbsp;(also called your
Digital Birth Certificate&#8482;
if the enrollment is performed by a notary&nbsp;in a face-to-face
setting), is to
be locked away by you, not used on a day-to-day basis.
Your Digital Birth Certificate will contain the same sort of
information as your paper birth certificate, plus information that was
established after your birth.<br />
<br />
The second, your general purpose
identity certificate, can be used every time you log on to a web site
or network. (Some people also like to use separate certificates for
signing files, for receiving encrypted files, and for logging on to
different networks but with MOI that shouldn't be necessary.<br />
<br />
Let's now
fill in the items to be included in your Foundational Identity
Certificate, and specify what you want disclosed in your general
identity certificate,
that is, to
any relying party to whom you have presented your general
certificate.&nbsp;</span></h2>
<h2><span style="font-weight: normal;">For the
latter you should be rather guarded, disclosing minimal information
about yourself (Recommended
values are indicated.)&nbsp;Later you'll be given the
opportunity to specify individuals and groups who might be entitled to
more, after signing your Personal NDA.&nbsp;</span></h2>
<table style="text-align: left; width: 100%;" border="1" cellpadding="2" cellspacing="2">
<tbody>
<tr>
<td style="text-decoration: underline;">Foundational
Certificate Item</td>
<td style="text-decoration: underline;">Value (enter)</td>
<td style="text-decoration: underline;">Recommendation</td>
<td style="text-decoration: underline;">Disclose?
(Y/N)</td>
</tr>
<tr>
<td>Prefix, such as Dr.</td>
<td style="color: red;">Can't get PHP input field to
work here</td>
<td>Disclose in General Certificate</td>
<td style="color: red;">nor here</td>
</tr>
<tr>
<td>First Name</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Middle Name</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Last Name</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Suffix (Jr., III, etc.)</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Country of Citizenship at birth</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Second Country of Citizenship at birth</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>First Country of Citizenship at Time of Enrollment</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Second Country of Citizenship at Time of Enrollment</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Public Key of Enrollment Officer</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Name and Jurisdiction of Enrollment Officer, if
Face-to-Face</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Nicknames, Aliases and Previous Names</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Your Identity Assertion Name (OpenID, I-Name, Card
Space, Shibboleth, Liberty, etc.</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Your Mother's Full Name At Birth</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Your Father's Full Name At Birth</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Your Address at Time of Birth, if known</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Your Date of Birth</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Your Place of Birth</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Name of Signer of Paper Birth Certificate</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Address of Place of Enrollment</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Coordinates of Place of Enrollment</td>
<td></td>
<td>Do Not Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Six-Digit Identity Quality Code</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Address for Request of Supplemental Information from
your MOI</td>
<td></td>
<td>Disclose in General Certificate</td>
<td></td>
</tr>
<tr>
<td>Issuing Certification Authority</td>
<td></td>
<td>Automatically Inserted by CA</td>
<td></td>
</tr>
<tr>
<td>Type of Algorithm</td>
<td></td>
<td>Automatically Inserted by CA</td>
<td></td>
</tr>
<tr>
<td>Validity Period of Certificate</td>
<td></td>
<td>Automatically Inserted by CA</td>
<td></td>
</tr>
<tr>
<td>Certificate Serial Number</td>
<td></td>
<td>Automatically Inserted by CA</td>
<td></td>
</tr>
</tbody>
</table>
<h2><span style="font-weight: normal;"><br />
<br />
<form id="whatdisclose" method="post" action="">
<p> <label for="prefix">Prefix, such as Dr.<?php if (isset($missing) && in_array('prefix', $missing)) { ?>
<span class="warning">Recommendation: Disclose.</span><?php } ?>
</label> <input name="yesprefix" id="prefix" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['state']).'"'; } ?></p>
<p> <label for="firstname">Your first name:
<?php if (isset($missing) && in_array('when', $missing)) { ?><span class="warning">Recommendation: Disclose.</span><?php } ?>
</label><input name="firstname" id="firstname" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['county']).'"'; } ?>&nbsp;
</p>
<br />
<p> <label for="birthname">Your full name at
birth, if different and if known:
<?php if (isset($missing) && in_array('when', $missing)) { ?><span class="warning">Recommendation: Do not disclose. Keep this
information in your MOI.</span><?php } ?>
</label><input name="firstname" id="firstname" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['county']).'"'; } ?>&nbsp;
</p>
<br />
<p> Please review the information above. Check for accuracy,
and make sure that you disclosure choices reflect your intentions.
Remember, you can always disclose additional information to a
particular relying party, but you cannot remove information from an
identity certificate once it has been signed by the certification
authority. So be conservative about what you disclose in your
certificate.&nbsp;</p>
<p>When you are satisfied that your disclosure choices are what
you want, click below. That will create a confidential record of
information about yourself. It will serve as the basis of a
biographical work about you whose purpose is to make your information
subject to copyright. In addition, your Personal NDA portion of your
MOI ensures that
companies only use your proprietary and confidential information under
the terms of the license that you grant to them. Your information is
your
personal intellectual property, under your control.
<br />
<br />
<br />
<input name="createMOI" id="createMOI" value="Create MOI (My Own Information Infrastructure)" type="submit" /> <br />
<br />
</p>
<p> Clicking below will cause the creation of an Affidavit of
Identity, to be printed and presented to a notary public if your
enrollment is to be Face-to-Face. The Affidavit
will serve as the basis of an oath to be recited by you in the presence
of the notary, after the notary has verified your identity. This will
in turn permit an Enrollment Officer to present a certificate signing
request, directing the certification authority to sign your identity
certificate, allowing the certification authority to attest to the
reliability of your identity whenever a relying party requires such
attestation.&nbsp;
<br />
<br />
<input name="createMOI" id="createMOI" value="Create Affidavit" type="submit" /> <br />
<br />
</p>
<p> Clicking below will create a form that will be submitted,
after your session with a Notary, to the Enrollment Officer in order to
create your Certificate of Identity.
Its contents
will
available to any relying party to whom you present your identity
credential.
<br />
<br />
</p>
<p> <input name="createCSR" id="createCSR" value="Create Identity Certificate Signing Request Form" type="submit" /> </p>
<br />
<br />
</form>
</span>
<form id="timeandplace" method="post" action="">
<p> <label for="where">City where enrollment
session is desired:<?php if (isset($missing) && in_array('where', $missing)) { ?>
<span class="warning">Please enter the name of the
location where an enrollment session is desired</span><?php } ?>
</label> <input name="where" id="state" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['state']).'"'; } ?></p>
<p> <label for="when">What date would you like
the enrollment session to take place:
<?php if (isset($missing) && in_array('when', $missing)) { ?><span class="warning">Please enter the date on which you would
like to have your enrollment session</span><?php } ?> </label>
<input name="when" id="when" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['county']).'"'; } ?>&nbsp;
</p>
<p> <input name="send" id="send" value="Schedule My Enrollment Session" type="submit" />
</p>
</form>
<br />
<br />
Complete this form to generate the affidavit that will be
used at your enrollment session.</h2>
<br />
<br />
<h1>Affidavit Form</h1>
<h2>Complete this form to generate the affidavit that will be
used at your enrollment session.</h2>
<div id="wrapper"><?php if ($_POST && isset($missing)) { ?>
<p class="warning">Please complete the missing item(s)
indicated.</p>
<?php } elseif ($_POST && $pdfmade) { ?>
<p><strong>Your affidavit has been created.</strong></p>
<?php include('includes/mail.inc.php'); } ?>
<form id="feedback" method="post" action="">
<p> <label for="name">Full Name:<?php if (isset($missing) && in_array('name', $missing)) { ?>
<span class="warning">Please enter your name</span><?php } ?>
</label><input name="name" id="name" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['name']).'"'; } ?></p>
<p> <label for="state">State to be enrolled in:<?php if (isset($missing) && in_array('state', $missing)) { ?>
<span class="warning">Please enter the state you will be
enrolling
in</span><?php } ?> </label> <input name="state" id="state" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['state']).'"'; } ?>&nbsp;
</p>
<p> <label for="county">County to be enrolled in:
<?php if (isset($missing) && in_array('county', $missing)) { ?><span class="warning">Please enter the county you will
be enrolling in</span><?php } ?> </label> <input name="county" id="county" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['county']).'"'; } ?>&nbsp;
</p>
<p> <label for="address">Home Address:<?php if (isset($missing) && in_array('address', $missing)) { ?>
<span class="warning">Please enter your address</span><?php } ?>
</label><input name="address" id="address" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['address']).'"'; } ?></p>
<p> <label for="birthdate">Birthdate:<?php if (isset($missing) && in_array('birthdate', $missing)) { ?>
<span class="warning">Please enter your birthdate</span><?php } ?>
</label><input name="birthdate" id="birthdate" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['birthdate']).'"'; } ?></p>
<p> <label for="birthplace">Birthplace:<?php if (isset($missing) && in_array('birthplace', $missing)) { ?>
<span class="warning">Please enter your birthplace</span><?php } ?>
</label><input name="birthplace" id="birthplace" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['birthplace']).'"'; } ?></p>
<p> <label for="mom">Mothers Full Name:<?php if (isset($missing) && in_array('mom', $missing)) { ?>
<span class="warning">Please enter your mother's full
name</span>
<?php } ?> </label> <input name="mom" id="mom" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['mom']).'"'; } ?></p>
<p> <label for="dad">Fathers Fullname:<?php if (isset($missing) && in_array('dad', $missing)) { ?>
<span class="warning">Please enter your father's full
name</span>
<?php } ?> </label> <input name="dad" id="dad" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['dad']).'"'; } ?></p>
<p> <label for="birthaddress">(optional) Address
at time of birth:</label> <input name="birthaddress" id="birthaddress" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['birthaddress']).'"'; } ?>
</p>
<p> <label for="nickname">(optional)
Nicknames/pen-names/aliases:</label> <input name="nickname" id="nickname" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['nickname']).'"'; } ?>&nbsp;
</p>
<p> <label for="social">(optional) Social
Security #:</label> <input name="social" id="social" class="formbox" type="text" /><?php if (isset($missing)) { echo 'value="'.htmlentities($_POST['social']).'"'; } ?>&nbsp;
</p>
<p> <input name="send" id="send" value="Schedule My Face-to-Face (DBC) Enrollment Session" type="submit" /> </p>
</form>
</div>
</body></html>