Can an Integrity Statement be signed electronically?

Yes. Under the federal ESIGN Act (15 U.S.C. §7001) and state UETA laws, electronic signatures are binding unless a statutory exception applies; confirm exceptions such as wills or certain court filings.

Do consumer-facing attestations need a disclosure?

Yes. Consumer-facing records require an ESIGN consumer disclosure showing the right to a paper copy and methods to withdraw consent per 15 U.S.C. §7001(c).

When is notarization required?

Notarization depends on document purpose and state law; deeds and certain powers of attorney commonly require notary acknowledgement and in some states witnesses.

What authentication level is appropriate?

Use email or SMS codes for low-risk attestations; use KBA, ID credential analysis, or multi-factor authentication for higher-risk vendor or regulatory attestations.

How should I store signed forms?

Store signed PDFs with a retained audit trail, encryption at rest, and retention metadata per applicable federal and state retention rules.

What if a signer’s name doesn’t match records?

Require corrected identification or an affidavit of identity; mismatched names can invalidate attestations and trigger re-submission or backup withholding in tax contexts.

Electronic Signature
Templates
Miscellaneous
Integrity Statement Form

Integrity Statement Form

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

INTEGRITY STATEMENT FORM

Parties

Client Name:

Client Address

Service Provider Name:

Provider Address

Recitals

WHEREAS, Client engages Service Provider to perform certain professional services and requires assurances that such services will be delivered with honesty, lawfulness, and in compliance with applicable ethical standards; and

WHEREAS, Service Provider affirms that it will conduct its performance free from conflicts of interest, corrupt practices, bribery, and any form of dishonest or fraudulent activity and will immediately disclose any actual or potential integrity concerns to Client in writing; and

NOW, THEREFORE, in consideration of the mutual covenants set forth herein and other good and valuable consideration, the parties agree as follows:

Scope of Work

Describe services and obligations

Payment Terms

Compensation Amount:

Payment Schedule and Method

Late Payment Remedy: If any payment is not received within days of the due date, Client may assess a late fee of on the outstanding balance or pursue other remedies permitted by law.

Term and Termination

Term Commencement Date:

Term Expiration Date:

Termination Notice

Integrity and Confidentiality

Service Provider represents, warrants, and covenants that, throughout the Term, it shall:

Comply with all applicable laws, regulations, and industry standards prohibiting bribery, corruption, and fraudulent practices.
Not offer, pay, solicit, or accept any improper benefit, gift, or payment to influence the performance of duties under this Agreement.
Maintain complete and accurate records relating to the Services and make such records available to Client upon reasonable request.

Confidential Information disclosed by either party shall be held in strict confidence and used solely for performance of this Agreement. Service Provider shall implement reasonable administrative, technical, and physical safeguards to protect Confidential Information and shall immediately notify Client upon any actual or suspected unauthorized disclosure.

Representations and Certifications

The undersigned certifies under penalty of law that the information contained in this Integrity Statement Form is true, complete, and accurate to the best of their knowledge, and acknowledges that a material misrepresentation may constitute a breach of contract and grounds for termination and other remedies.

Please indicate acknowledgement of the foregoing by checking each applicable statement:

I certify that there are no known conflicts of interest that would impair my ability to perform the Services in an impartial and lawful manner.

I certify that neither I nor any entity I control has offered or provided any improper payments or gifts to obtain or influence the award of this engagement.

I agree to promptly disclose in writing any event, relationship, or circumstance that could reasonably be expected to give rise to an integrity concern during the Term.

Governing Law and Remedies

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to choice-of-law principles. The parties agree that equitable relief, including injunctive relief, shall be available to enforce the provisions of this Agreement in addition to all other legal remedies.

Entire Agreement

This Integrity Statement Form, together with any attachments or documents incorporated by reference, constitutes the entire agreement between the parties with respect to integrity assurances and supersedes all prior or contemporaneous oral or written agreements, representations, and understandings. Any amendment must be in writing and signed by authorized representatives of both parties.

Notices

Where notices are to be sent to Client Where notices are to be sent to Provider

Client Printed Name:

By:

Date:

Provider Printed Name:

By:

Date:

What the Integrity Statement Form Is and When It’s Used

An Integrity Statement Form is a written declaration in which an individual or entity affirms accuracy, ethical compliance, or non-conflict with respect to a transaction, bid, application, or record. Typical uses include vendor integrity attestations, grant or contract compliance statements, employee conflict-of-interest disclosures, and certifications for procurement or regulatory reporting. The form records declarative facts, signatures, dates, and any necessary supporting details and creates an auditable record used by organizations to document due diligence and meet governance or funding requirements.

Why an Integrity Statement Form Matters for Recordkeeping and Risk Control

Using a clear Integrity Statement Form reduces ambiguity about representations made by signers, creates an evidentiary record for audits or disputes, and supports compliance programs by documenting intent and consent. Well-structured forms reduce downstream verification time and strengthen internal controls.

Who Typically Completes an Integrity Statement Form

Organizations rely on these forms across procurement, grants, HR, legal, and finance functions to capture attestations from individuals or entities before awarding funds, executing contracts, or onboarding vendors.

Procurement teams and contracting officers use the form to screen vendors and document declarations prior to award.
Human resources and ethics officers collect attestations from employees and contractors to disclose conflicts of interest or gifts.
Grant administrators and compliance officers require attestations from recipients as part of funding agreements.

The form is also used by third parties, such as subcontractors or consultants, to certify compliance during onboarding and during recurring reporting periods.

Who Can Sign and What Their Role Means

Authorized Representative

An individual with legal authority to bind the company (officer or agent). Their signature indicates the entity accepts the statements and any resulting obligations; verify corporate delegation or power-of-attorney when applicable.

Individual Declarant

A person signing in their own capacity (employee, consultant, vendor). Their signature attests to personal facts or behaviors; employers should confirm identity and signatory authority for organization-level attestations.

Step-by-Step: Filling Out an Integrity Statement Form

Complete the form in a consistent order to minimize errors and ensure all attestations are present before signing.

01

Review Instructions: Read form guidance and required attachments before entering information.
02

Provide Identifiers: Enter legal name, entity, address, and taxpayer or registration numbers.
03

Answer Declarations: Check each statement box and supply brief explanations where the form allows.
04

Sign and Date: Sign in the signature block; include witness or notary steps if required.

How the Form Moves Through a Typical Approval Workflow

Most organizations route completed Integrity Statement Forms through a defined review path that includes verification, approval, and archival steps.

Submit: Sender uploads form and designates signers or generates a signing link.
Authenticate: Signer verifies identity by email, SMS code, or stronger methods if required.
Review: Compliance or procurement reviews answers and supporting documents.
Archive: Approved form is stored with audit trail and retention metadata.

Configuring an Online Integrity Statement Workflow

When setting up an eSubmission flow, configure fields, authentication, and retention to match policy and regulatory needs.

Field	Configuration
Signature Type	Electronic signature with audit trail; consider advanced auth for high-risk forms
Authentication	Email link or SMS code for low-risk; KBA or ID analysis for higher assurance
Routing	Sequential approvals (signer → compliance → legal) with reminders
Storage	Secure PDF with audit log and retention tags

Technical Considerations for eSubmission and eSigning

Choose a platform that supports the signature, authentication, and retention levels your organization requires.

Document Formats: PDF, DOCX, and interoperable exports
Integrations: Connectors for CRM, ERP, and cloud storage
Security: Encryption in transit and at rest

Confirm the platform supports required compliance standards (ESIGN/UETA) and any industry-specific controls such as HIPAA or 21 CFR Part 11 if applicable.

Core Elements to Include in a Professional Integrity Statement Form

A complete form balances clear assertions, identification, signature mechanics, and evidence attachments to support transparency and auditability.

Identification

Full legal name, entity, address, and taxpayer or registration number to uniquely identify the declarant and prevent ambiguity.

Declarative Statements

Specific, itemized assertions (conflict-of-interest, debarment status, regulatory compliance) rather than broad generalities to aid verification.

Supporting Details

Fields for explanations, dates, contract references, and attachments that substantiate responses where the form permits.

Signature Block

Dedicated area for signature, printed name, title, and date; include witness and notary lines when required by law or policy.

Authentication

Method of signer identity verification (email, SMS, KBA, ID analysis) recorded in the audit trail for evidentiary value.

Audit Trail

Machine-readable audit log capturing timestamps, IP addresses, and user actions to support later review or dispute resolution.

Security and Compliance Controls to Capture

Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encryption

Audit Logs: Tamper-evident action history

Access Controls: Role-based permissions

Authentication: Multi-factor options available

Certifications: SOC 2, ISO 27001, HIPAA BAA

Common Pitfalls to Avoid When Preparing an Integrity Statement

Using informal or inconsistent names that do not match government records, which can delay verification and require re-submission.
Failing to attach required supporting documents or evidence, causing reviewers to reject the attestation or ask for additional proof.
Applying vague language in declarations (for example, 'reasonable efforts') rather than specific factual statements that reviewers can evaluate.
Skipping authentication or weak signer verification for high-risk attestations, increasing exposure to fraud or disputes.

Consequences of Incorrect or Misleading Integrity Statements

Contract Voiding: May void agreements

Debarment: Risk of vendor suspension

Regulatory Fines: Potential agency penalties

Civil Liability: Exposure to lawsuits

Tax Consequences: Backup withholding triggers

Criminal Risk: Intentional false statements can lead to prosecution

Timing Considerations and Typical Deadlines

Set deadlines and internal SLAs for collection and review to ensure attestations are current and enforceable when relied upon.

Submission Timing:

Require form prior to contract award or payment authorization.

Periodic Renewal:

Use annual re-attestation for ongoing contracts or as policy dictates.

Retention Start:

Retention begins on signature date in most programs.

Dispute Window:

Set an internal review window for any challenges to accuracy.

Audit Readiness:

Maintain easy retrieval for audits for the retention period.

Representative eSignature Vendor Comparison for Integrity Statement Workflows

Compare basic price points and common capability markers for eSignature vendors. signNow appears first for direct price and capability reference.

	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	No	No	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions and Troubleshooting Tips

Answers to common questions about validity, signatures, and submission help avoid processing delays and compliance issues.

Need help? Contact support

Can an Integrity Statement be signed electronically?
Yes. Under the federal ESIGN Act (15 U.S.C. §7001) and state UETA laws, electronic signatures are binding unless a statutory exception applies; confirm exceptions such as wills or certain court filings.
Do consumer-facing attestations need a disclosure?
Yes. Consumer-facing records require an ESIGN consumer disclosure showing the right to a paper copy and methods to withdraw consent per 15 U.S.C. §7001(c).
When is notarization required?
Notarization depends on document purpose and state law; deeds and certain powers of attorney commonly require notary acknowledgement and in some states witnesses.
What authentication level is appropriate?
Use email or SMS codes for low-risk attestations; use KBA, ID credential analysis, or multi-factor authentication for higher-risk vendor or regulatory attestations.
How should I store signed forms?
Store signed PDFs with a retained audit trail, encryption at rest, and retention metadata per applicable federal and state retention rules.
What if a signer’s name doesn’t match records?
Require corrected identification or an affidavit of identity; mismatched names can invalidate attestations and trigger re-submission or backup withholding in tax contexts.

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