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Click ‘Get Form’ to open the Verified Statement of Applicant in the editor.
Begin by entering the PUC Application Docket No. at the top of the form, followed by your Legal Name and Trade Name, if applicable.
Fill in your principal place of business address, including Street Address, City or Municipality, State, and Zip Code.
In Section 1, identify the person making the statement on behalf of the applicant. Include their name, title, business address, and telephone number.
Proceed to Section 2 and list any affiliations with other carriers along with a brief description.
Continue through Sections 3 to 12 by providing detailed information about your business experience, facilities, employee structure, vehicle safety program, insurance coverage plans, customer service standards, and financial data as required.
Ensure all sections are completed clearly; if more space is needed for explanations, attach additional pages referencing the item numbers.
Finally, review your entries for accuracy before signing and dating the verification section at the end of the document.
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What is a verification on oath or affirmation form PA?
(b) Statements under penalty. --A person commits a misdemeanor of the third degree if he makes a written false statement which he does not believe to be true, on or pursuant to a form bearing notice, authorized by law, to the effect that false statements made therein are punishable.
Does PA require an E-verify?
If no other format is prescribed, a Verification on Oath or Affirmation form may be used when an individual is signing and swearing (or affirming) that certain written statements are true. Each pad includes helpful how-to instructions and 100 certificates in a convenient tear-off form.
What states is E-Verify mandatory?
Am I required to participate in E-Verify? No. While participation in E-Verify is voluntary for most employers, other employers may be required by State law or Federal regulation to use E-Verify. For example, most employers in Arizona and Mississippi are required to use E-Verify.
Is PA an E-Verify state?
Contracts Exempt from the E-Verify Federal Contractor Rule A contract is considered exempt if any one of the following applies: It is for fewer than 120 days. It is valued at or below $150,000. All work is performed outside the United States.
What is a statement under penalty charge in PA?
(b) The complaint shall be verified by the plaintiff upon personal knowledge or information and belief or by any other person having sufficient knowledge or information and belief, who shall set forth the source of the information as to matters not stated upon his or her own knowledge and the reason why the
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18 Pa csa 4904Pa rcp 1024Pa Rules of Civil Procedure
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28 Pa. Code 1230a.45 - Verifications and affidavits
Verification means a signed written statement of fact supported by oath or affirmation or made subject to the penalties of 18 Pa.CS 4904 (relating to unsworn
Standard MOD-026-1 Verification of Models and Data
(Requirement R2). Document circumstance with a written statement and include with the verified model, documentation and data provided to the Transmission.
The Verified Statement of the Applicant is more or less a business plan, or your proposal for providing the transportation service for which you are making
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