To get a proper definition, you'll need to provide more context, such as:
* Where did you encounter this form? (e.g., a website, a document, a conversation)
* What is the context of the form? (e.g., what is it used for? what information does it collect?)
* Is there any other information associated with the form? (e.g., a title, a description, a reference number)
With more information, I can help you find the correct form and understand its purpose.