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Ukraine Dating Agency

Example of Lady's form stating she wishes to share her contact information

I, __________, acknowledge and attest to the fact that Ukraine Dating Agency has provided me, in my primary language, Ukrainian/Russian with the following information prior to my upcoming meeting with ______________ (hereinafter referred to as "the United States client"),

1. A copy of any records retrieved from the search by Ukraine Dating Agency of the U.S. National Sex Offender Public Registry, or of the relevant State sex offender public registry for any State not yet participating in the U.S. National Sex Offender Public Registry, in which the United States client has resided during the pre-vious 20 years, or docu-mentation confirming that such search retrieved no records; and

2. Background information, signed and certified by the United States client, describing and attesting to the following personal information:

a. Any temporary or permanent civil protection order or restraining order issued against the United States client.

b. Any Federal, State, or local arrest or conviction of the United States client for homicide, murder, man-slaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploi-tation, incest, child abuse or neglect, torture, traf-ficking, peonage, holding hostage, involuntary ser-vitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or stalking.

c. Any Federal, State, or local arrest or conviction of the United States client for-


i. solely, principally, or incidentally engaging in prostitution; 
ii. a direct or indirect attempt to procure prostitutes or persons for the purpose of prostitu-tion; or 
iii. receiving, in whole or in part, of the proceeds of prostitution.

d. Any Federal, State, or local arrest or conviction of the United States client for offenses related to con-trolled substances or alcohol. 
e. Marital history of the United States client, including whether the client is currently married, whether the client has previously been married and how many times, how previous marriages of the client were terminated and the date of termination, and whether the client has previously sponsored an alien to whom the client was engaged or married. 
f. The ages of any of the United States client's children who are under the age of 18. 
g. All States and countries in which the United States client has resided since the client was 18 years of age. 
h. The information and resources pamphlet on domestic violence developed under section 833(a) of the Inter-national Marriage Broker Regulation Act of 2005 setting forth the legal rights and resources for immigrant victims of domestic violence as well as information on the following: 

i. The K nonimmigrant visa application process and the marriage-based immigration process, including condi-tional residence and adjustment of status. 
ii. The illegality of domestic violence, sexual assault, and child abuse in the United States and the dynamics of domestic violence. 
iii. Domestic violence and sexual assault services in the United States, including the National Domestic Violence Hotline and the National Sexual Assault Hotline. 
iv. The legal rights of immigrant victims of abuse and other crimes in immigration, criminal justice, family law, and other matters, including access to protection orders. 
v. The obligations of parents to provide child support for children. 
vi. Marriage fraud under United States immigration laws and the penalties for committing such fraud. 
vii. A warning concerning the potential use of K non-immigrant visas by United States citizens who have a history of committing domestic violence, sexual assault, child abuse, or other crimes and an explanation that such acts may not have resulted in a criminal record for such a citizen. 


name ____________________________