The image http://i49.tinypic.com/339q3hi.jpg depicts what you'll see on your screen if you inadvertently send a form with the present date rather than your birthdate. It's nothing more than a ploy to extract personal information from you. They're not satisfied with knowing your cell phone number (which allows them to identify your dwelling).

Goodbye to *that* Gmail account. Google will get my credit card number and picture ID from my cold, dead hands!