Forever Age Certification — Manufacturer Application Form

Section 1 — Manufacturer Information

Legal Name of Manufacturer:

Country of Incorporation:

Company Address:

Website:

Section 2 — Contact Information

Primary Contact Name:

Title:

Email Address:

Phone Number:

Section 3 — Robot Model Information

Robot Model Name:

Model Number:

Hardware Serial Number Format:

Production Status:

☐ Prototype
☐ Pre-production
☐ Production

Estimated Annual Production Volume:

Section 4 — Forever Age Class Selection

Select requested Forever Age certification:

☐ FA-18 Intimate Companion Class
☐ FA-25 Assistant Class
☐ FA-35 Professional Class
☐ FA-55 Companion Class
☐ FA-75 Mentor Class

Section 5 — Identity Architecture Description

Describe robot identity architecture:

Section 6 — Robot Registry Integration

Robot Registry status:

☐ Integrated
☐ Pending Integration
☐ Not yet integrated

Registry ID format (if assigned):

Section 7 — Certification Badge Usage Agreement

Manufacturer agrees to:

☐ Use Forever Age certification badge only for certified models
☐ Maintain identity integrity
☐ Register each certified robot in Robot Registry

Section 8 — Declaration

Authorized representative certifies information is accurate.

Name: _________________________

Title: _________________________

Signature: _________________________

Date: _________________________