STATEMENT OF REQUEST for FACEBOOK PAGE ADMIN

_____________________________

This letter is submitted by

[your name]
Owner of [your company].
[your mailing address]

This letter is submitted to

Facebook Pages Support

Dear Facebook:

The following instrument shall summarize my Request in accordance with our previous
discussions. This Request was preceded through prior negotiations, which took place via Email
and via the Facebook Support Inbox.

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As per our conversation, the mutually agreed upon terms are as follows:

A. REQUEST TO GAIN ACCESS TO THE PAGE “[PAGE NAME]”

Facebook and I are in agreement to the following with regards to:

Processing a Request for my Facebook Account to be added as Administrator (“Admin”) of the

Facebook Page [name of your page]

My Facebook Account Profile: [insert URL]

The page I am requesting access to: [insert URL]

Facebook has agreed to Process this Request if the following items are provided:

1. A copy of a valid government-issued photo ID, such as a current driver's license or a passport,
of the individual signing the statement.

2. A notarized and signed statement from a person with sufficient knowledge and authority over
this matter that includes all of the following:

a) A description of your relationship to the Page (including your authority to request a change in
the person(s) who manage the Page, as applicable);

b) The name of the current person(s) who manage the Page, as applicable;

c) The relationship of the above person(s) to the Page;

d) An explanation of your request, and whether there has been a termination of the employment
and/or business relationship with the named person(s), as applicable;

e) All documentation supporting your request INCLUDING govt. issued business license or
certificate of incorporation.

f) The Facebook account or email address associated with the Facebook account that you wish to
have added as the new admin of the Page; and

g) A declaration under penalty of perjury that the information you have provided is true and
accurate (your statement must include this language).

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B. FULFILMENT OF REQUIREMENTS

Pursuant to section A of this document, the parties submitting this request affirm the fulfillment
of all requirements for Processing of request.

The following articles are included with this document, relevant to each requirement:

1. See my valid govt. issued photo ID is included in this document;

2. See this document;

a) I am the owner of [business name] and the original creator of the Facebook Page;

b) At time of submission, there are no users with the Admin role present on the page;

c) See item b above;

d) See item b above;

e) See [type of document included govt. issued business license/certificate of

incorporation/etc] included in this document [or put “N/A” if none included];

f) The Facebook Account requesting the Admin role is [your name].

Link to my profile: [insert URL].
The email address associated with this account is [the email you use to log in to
Facebook]

g) I declare under penalty of perjury that the information I have provided to Facebook is
true and accurate.

[your company name]

(Company Name – Originator)

___________________________________________
(Signature of [your name], Owner)

[your street address]

(Address)

, , .
(City) (State/Province) (Zip/Postal Code)

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