--- /dev/null
+<table class="table">
+<thead>
+<tr><th colspan="2"><?=_Verification Confirmation?></th></tr>
+</thead>
+<tbody>
+<tr><td colspan="2"><?=_Please check the following details match against what you witnessed when you met ${name} in person. You MUST NOT proceed unless you are sure the details are correct. You may be held responsible by the SomeCA Arbitrator for any issues with this Verification.?>
+</td></tr>
+<? foreach($names) { ?>
+ <tr>
+ <td><?=_Name?>: </td>
+ <td><input type="checkbox" name="verifiedName" value="<?=$nameId?>"<?=$checked?>><span class="accountdetail"><?=$nameExplicit?></span></td>
+ </tr>
+<? } ?>
+ <tr>
+ <td><?=_Date of Birth?>: </td>
+ <td><span class="accountdetail dob"><?=$dob?> (<?=$dobFmt2?>)</span></td>
+ </tr>
+ <tr>
+ <td><input type="checkbox" name="certify" value="1" required></td>
+ <td><?=_I certify that ${name} has appeared in person.?></td>
+ </tr>
+ <tr>
+ <td><?=_Location Country?></td>
+ <td>
+ <?=$countryCode?>
+ </td>
+ </tr>
+ <tr>
+ <td><?=_Location?></td>
+ <td><input class="form-control" type="text" name="location" value="<?=$location?>" required></td>
+ </tr>
+ <tr>
+ <td><?=_Date?></td>
+ <td><input class="form-control" type="text" name="date" value="<?=$date?>" required><br/><?=_The date when the verification took place. Please adjust the date if you verified the person on a different day (YYYY-MM-DD).?></td>
+ </tr>
+ <tr>
+ <td><input type="checkbox" name="assertion" value="1" required></td>
+ <td><?=_I believe that the assertion of identity I am making is correct, complete and verifiable. I have seen original documentation attesting to this identity. I accept that the SomeCA Arbitrator may call upon me to provide evidence in any dispute, and I may be held responsible.?></td>
+ </tr>
+ <tr>
+ <td><input type="checkbox" name="rules" value="1" required></td>
+ <td><?=_I have read and understood the Terms of Service (!(/policy/ToS)ToS!'</a>'), Verification Policy and the Verification Handbook. I am making this verification subject to and in compliance with the ToS, Verification Policy and Handbook.?></td>
+ </tr>
+ <tr>
+ <td><?=_Policy?>: </td>
+ <td>
+ <?=_!(/policy/ToS)Terms of Service!'</a>'?>
+ - <?=_!(/policy/verification)Verification Policy!'</a>'?></a>
+ - <?=_!(/wiki/verificationHandbook)Verification Handbook!'</a>'?></a>
+ </td>
+ </tr>
+ <tr>
+ <td><?=_Points?></td>
+ <td><input class="form-control" type="text" name="points" required><br/>(Max. <?=$maxpoints?>)</td>
+ </tr>
+ <tr>
+ <td><?=_Type?></td>
+ <td><select name="verificationType"><? foreach($ats) { ?><option value="<?=$id?>"<?=$sel?>><?=$type?></option><? } ?></select></td>
+ </tr>
+ <tr>
+ <td><input type="checkbox" name="passwordReset" value="1" <? if($aword) { ?>checked<? } ?>></td>
+ <td><?=_I have conducted a password reset with verification. The established "A-Word" is:?><input type="text" name="passwordResetValue" value="<? if($aword) { ?><?=$aword?><? } ?>"></td>
+ </tr>
+ <tr>
+ <td colspan="2">
+ <input class="btn btn-primary" type="submit" name="process" value="<?=_I confirm this verification?>" />
+ <input class="btn btn-default" type="submit" name="cancel" value="<?=_Cancel?>" />
+ </td>
+ </tr>
+ </tbody>
+</table>