Social security number affidavit licensure: Fill out & sign online

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Click ‘Get Form’ to open the Bureau of Professional Licensing form in the editor.
Begin by entering your Legal Name (First, Middle, Last) in the designated field. Ensure that it matches your official documents.
Next, provide your Telephone Number. This is important for any follow-up communication regarding your application.
Select your License Type from the dropdown menu. Make sure to choose the correct type relevant to your profession.
Input your Date of Birth in the format MM/DD/YYYY. This information is crucial for identity verification.
If applicable, enter your 10-Digit MI Permanent ID/License Number. This helps in tracking your application status.
Provide your Email Address for electronic correspondence and updates about your application.
If you have a Social Security Number, enter it in the specified field. If not, complete the waiver section by providing a reason and signing where indicated.
Finally, review all entered information for accuracy before submitting. Use our platform’s features to save or print a copy for your records.

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