Can this be signed electronically?

Yes. Electronic signatures satisfy federal ESIGN Act requirements (15 U.S.C. ch. 96) and UETA in most states, provided intent, consent, attribution, and retention are met. Confirm recipient acceptance and any industry-specific requirements first.

Is notarization required?

Not usually, unless the recipient or jurisdiction requires it (for example, some real estate or government filings). Confirm whether a notary or RON session and witness signatures are specified in the contract or local law.

What happens if the signer name differs?

If the legal entity or signer name does not match registration records, the document may be rejected or require corrective affidavits. Use exact registered names to avoid verification delays.

How should supporting exhibits be attached?

Attach exhibits as clearly labeled PDFs and reference them in the scope and supporting references sections. Maintain the exhibit list in the statement for easy audit tracing.

Can a delegated manager sign?

Only if the signer has documented authority under company bylaws or a power-of-attorney. The recipient may require proof of delegation or an officer’s confirmation.

How long should copies be kept?

Retain executed copies and audit logs per applicable rules: IRS (3 years), HIPAA (6 years), and any longer state or contract-specific retention periods. Consult counsel for high-risk matters.

Electronic Signature
Templates
Miscellaneous
Business Statement of Assurances

Business Statement of Assurances

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

BUSINESS STATEMENT OF ASSURANCES

RECITALS

WHEREAS, the Assuring Party is a business organized as: , operating as , with principal place of business at .

WHEREAS, the Receiving Party is: , located at .

WHEREAS, Assuring Party desires to make certain assurances, warranties and representations to Receiving Party in connection with the performance of services and related business activities described below, effective as of .

SCOPE OF WORK

Description of Services / Scope

PAYMENT TERMS

Total Contract Amount: . Payment will be made in accordance with the following schedule:

Payment Schedule Late Payment Fee Invoicing and Payment Instructions

TERM AND TERMINATION

Term: This Statement of Assurances commences on and continues until unless earlier terminated in accordance with this section.

Either party may terminate this agreement for convenience upon days' prior written notice. Either party may terminate immediately for material breach that remains uncured for thirty (30) days after written notice of breach. Upon termination, Assuring Party shall deliver any materials and final invoices and shall be entitled to payment for work performed through the termination date, subject to setoff for any damages resulting from breach.

CONFIDENTIALITY

The parties acknowledge that in connection with performance under this Statement of Assurances, each may receive Confidential Information of the other. "Confidential Information" means non-public business, technical, financial, customer and other proprietary information. The recipient shall (i) use Confidential Information solely for the purposes of performing its obligations hereunder, (ii) not disclose Confidential Information to any third party except to those employees, agents or subcontractors with a need to know who are bound by confidentiality obligations at least as protective as these, and (iii) take reasonable measures to protect Confidential Information from unauthorized disclosure. Confidential Information shall not include information that is or becomes publicly known through no fault of the recipient or that the recipient can demonstrate was lawfully in its possession prior to disclosure.

ASSURANCES AND CERTIFICATIONS

By checking each box below and signing, Assuring Party affirms that the following statements are true and correct as of the Effective Date and will remain true during the term unless promptly disclosed in writing to Receiving Party.

Complies with all applicable federal, state and local laws, regulations and ordinances applicable to its business and performance under this Statement.

Performance does not and will not violate any agreement, obligation, judgment, or order by which Assuring Party is bound and does not create any conflict of interest with Receiving Party.

Assuring Party, its principals and key personnel are not debarred, suspended or otherwise ineligible to participate in government contracts or employment.

Maintains insurance coverage customary for the industry and sufficient to cover liabilities arising from performance, and will provide certificates of insurance upon reasonable request.

Will process personal data in compliance with applicable data protection laws and implement reasonable technical and organizational measures to protect such data.

All information, representations and documentation provided to Receiving Party are true, accurate and complete to the best of Assuring Party's knowledge.

GOVERNING LAW

This Statement of Assurances shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that State for all disputes arising out of or relating to this Statement.

ENTIRE AGREEMENT

This Statement of Assurances, together with any exhibits or attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior agreements, understandings and communications, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

NOTICES

Notices to Assuring Party Notices to Receiving Party

AUTHORITY TO SIGN

Each individual signing below represents and warrants that they are authorized to execute this Statement of Assurances on behalf of the party indicated and that their signature binds that party to the terms herein.

Assuring Party (Printed Name):

By (Signature):

Date:

Receiving Party (Printed Name):

By (Signature):

Date:

What a Business Statement of Assurances Is and when it’s used

A Business Statement of Assurances is a written declaration by a company affirming compliance with specified legal, regulatory, or contractual requirements. It typically identifies the reporting entity, scope of assurance (for example, compliance with grant terms, procurement conditions, or regulatory standards), applicable time period, and a signature block for an authorized officer. Organizations use this document to demonstrate good-faith adherence to obligations, to satisfy third-party audits, or to meet funding and contract certification requirements in commercial and government contexts.

Why a clear Statement of Assurances matters

A concise Business Statement of Assurances creates an auditable record that clarifies responsibilities, reduces ambiguity in compliance reviews, and supports timely approvals by counterparties or agencies.

Who typically prepares and signs this statement

The precise preparer and signer depend on internal authority lines and the certification terms in the underlying contract or regulation.

Procurement teams and contract managers who must certify compliance with bid terms and supplier requirements.
Grant administrators and finance officers attesting to use of funds and adherence to program rules.
Corporate officers (e.g., CFO, General Counsel) authorized to make formal compliance attestations on behalf of the business.

Typical signers and their roles

Chief Financial Officer

As the business’s financial officer, the CFO may sign assurances concerning financial controls, grant expenditures, or cost allocations; their signature carries authority for monetary matters and audit responsiveness.

General Counsel

Legal officers often sign assurances tied to regulatory compliance, representations about legal status, or disclosures about litigation, providing legal accountability and interpretation of obligations.

Core components to include in a professional Statement of Assurances

Include a clear structure so reviewers can verify assertions quickly and auditors can trace sources.

Cover information

Entity name, mailing address, point of contact, and business identifier (EIN or DUNS) so the document is attributable and searchable.

Scope of assurance

Concise description of the activity or requirements being assured (for example, compliance with grant terms, procurement specifications, or data-protection measures).

Effective period

Start and end dates for the period covered by the assurance; these define the timeframe auditors will review.

Specific commitments

Clear, itemized statements of the controls, policies, or procedures in place that satisfy each requirement being certified.

Supporting references

Cite governing contract sections, grant conditions, policy documents, or regulatory citations that the assurances address.

Signature block

Authorized signer name, title, date, and contact details; include notary or witness lines if required by the recipient or jurisdiction.

Data points and compliance items to state succinctly

Entity Identifier: EIN or DUNS

Governing Law: Named state

Assurance Period: MM/DD/YYYY

Authorized Signer: Name and title

Supporting Doc List: Exhibit references

Notarization: If required

Step-by-step: completing a Business Statement of Assurances

Follow these sequential steps to prepare, review, and sign the statement so it meets contract or regulatory requirements.

01

Gather references: Collect related contracts, grant terms, and policy documents for accurate citations.
02

Draft assertions: Write clear, itemized assurances tied to specific obligations.
03

Internal review: Have legal and finance review wording and authority to sign.
04

Execute: Sign, notarize if required, and retain copies for audit.

Configuring an electronic workflow for this statement

Set up a simple, auditable workflow that captures signer identity, sequence, and retains an unalterable audit trail.

Field	Configuration
Signer order	Specify sequential or parallel signing
Authentication	Email link, SMS code, or stronger KBA if required
Attachments	Allow supporting exhibits as PDFs
Audit settings	Enable full event logging and signed certificate

Digital signing considerations and technical requirements

Ensure the platform supports retention, exportable audit reports, and any required regulatory features (for example, HIPAA BAA if health data is involved).

File formats: PDF, DOCX
Authentication: Email or SMS code
Integrations: CRM and storage

Typical eSubmission flow for an assurance statement

A reliable eSubmission workflow reduces friction and preserves an evidentiary record for audits and counterparties.

Prepare document: Upload final statement and append exhibits.
Place fields: Add signature, date, and text fields as required.
Send to signers: Enter signer emails and routing order.
Record completion: System captures IP, timestamps, and certificate.

Timing and expected processing windows

Deadlines depend on the recipient’s instructions, contract clauses, or grant conditions; confirm the required submission date before finalizing the statement.

Submission deadline:

Follow contract or agency-specified dates; late submissions may be rejected.

Internal review time:

Allow sufficient lead time for legal and finance review.

Processing expectation:

Recipient processing times vary; confirm their SLA when possible.

Record retention start:

Retention begins on the signature or effective date.

Amendment window:

Check if recipient permits post-execution corrections and the timeframe for those changes.

Common preparation errors to avoid

Mismatched legal names between the statement and registration documents, which can delay verification and acceptance.
Vague scope language that fails to tie assurances to specific contract clauses or grant conditions.
Missing or incorrect effective dates that change the covered reporting period and complicate audits.
Using initials or informal signatures where the recipient requires an authorized officer’s full signature or notarization.

Risks and potential consequences of incorrect assurances

Contract rejection: Material errors may void or disqualify the submission

Financial liability: Incorrect assurances can trigger repayment obligations

Audit findings: May lead to audit exceptions and remediation

Regulatory action: Potential fines or enforcement depending on subject matter

Reputational harm: Loss of trust with funders or partners

Criminal exposure: In rare cases, false statements may carry criminal penalties

Representative eSignature vendor comparison for executing assurance statements

Basic pricing and key plan differences for common eSignature vendors. signNow is listed first per table convention; verify each vendor’s current plans directly with the vendor.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently asked questions and practical answers

Practical answers to common questions about preparing, signing, and storing a Business Statement of Assurances.

Need help? Contact support

Can this be signed electronically?
Yes. Electronic signatures satisfy federal ESIGN Act requirements (15 U.S.C. ch. 96) and UETA in most states, provided intent, consent, attribution, and retention are met. Confirm recipient acceptance and any industry-specific requirements first.
Is notarization required?
Not usually, unless the recipient or jurisdiction requires it (for example, some real estate or government filings). Confirm whether a notary or RON session and witness signatures are specified in the contract or local law.
What happens if the signer name differs?
If the legal entity or signer name does not match registration records, the document may be rejected or require corrective affidavits. Use exact registered names to avoid verification delays.
How should supporting exhibits be attached?
Attach exhibits as clearly labeled PDFs and reference them in the scope and supporting references sections. Maintain the exhibit list in the statement for easy audit tracing.
Can a delegated manager sign?
Only if the signer has documented authority under company bylaws or a power-of-attorney. The recipient may require proof of delegation or an officer’s confirmation.
How long should copies be kept?
Retain executed copies and audit logs per applicable rules: IRS (3 years), HIPAA (6 years), and any longer state or contract-specific retention periods. Consult counsel for high-risk matters.

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