Consent Form for Verification of Information
Purpose:
This form serves to confirm that the applicant has reviewed the information listed on the application review form provided by the agent and agrees that it is accurate to the best of their knowledge.
Applicant Information:
Full Name: __________________________________
Application ID Number: ________________________
Date: ______________________________________
Consent Statement:
I, the undersigned, hereby confirm that I have thoroughly reviewed the information presented on the application review form provided to me by the agent. I acknowledge that this information is correct and accurate to the best of my knowledge. I understand that the accuracy of this information is crucial for the processing of my application.
By signing this consent form, I acknowledge that any discrepancies or inaccuracies may affect the outcome of my application, and I take full responsibility for the information provided.
Signature:
Applicant's Signature
Date:
Agent's Information (Optional):
Agent's Name: __________________________
Agent's Contact Information: _______________
Date of Review: __________________________
Note:
A copy of this signed consent form will be provided to the applicant for their records.