H1134: Fill out & sign online

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Click ‘Get Form’ to open the verification assistance form in the editor.
Begin by answering the first question: 'Does consumer live with you?' Circle 'Yes' or 'No'. If 'Yes', provide your address where both you and the member reside. If 'No', enter the address where the member is currently living.
Next, attest to how long the member has been living at the provided address by filling in the date. Also, indicate how long you have known the member in years or months.
Answer whether the member pays rent by circling 'Yes' or 'No'. If they do, specify the amount and frequency of payment.
In this section, attest to the employment status of the member. Fill in their employer's name and income details if employed, or state that they are unemployed and who provides for their necessities.
Add any additional comments that may be relevant to your verification.
Finally, complete your personal information including your name, relationship to the member, signature, date signed, telephone number, and address before submitting.

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