Establishing secure connection…Loading editor…Preparing document…

Personal Information Statement

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

PERSONAL INFORMATION STATEMENT

Purpose: This Personal Information Statement is provided by the undersigned to assist in evaluating credit, services, or other financial accommodations. The information provided below is true, complete and correct to the best of the undersigned's knowledge. The undersigned understands that materially false or misleading statements may be the basis for denial of credit, termination of services, or other legal action.

Applicant Identification

Applicant Name:

Social Security Number:

Date of Birth:

Place of Birth:

Home Phone:

Mobile Phone:

Email:

Residence History

Employment and Income

Position:

Employed Since:

Supervisor:

Assets

Liabilities

Monthly Expenses (approximate)

Contingent and Legal Matters

Are you a defendant in any material legal action, or party to any pending litigation?

Have you ever declared bankruptcy or had a judgment entered against you?

References

Authorization and Certification

I certify that the information contained in this Personal Information Statement is true, correct and complete. I understand that the recipient of this statement may rely upon the information provided in evaluating my creditworthiness or eligibility for services. I authorize the recipient to verify any information supplied, to obtain consumer credit reports, and to contact employers, banks, trade creditors, and references named herein for verification. This authorization shall remain in effect until revoked in writing.

I understand that knowingly making a false statement or omitting material information may constitute fraud and may be punishable by civil or criminal penalties under applicable law.

Notary / Administrative Use

Notary / Official: Complete if notarization is required. Provide name, commission number and expiration date. (This section is for administrative completion and does not substitute the applicant's signature below.)

Applicant Printed Name:

Signature:

Date:

Enter text✕
Prepare your document for signing right on this page
  • 01 Edit the text and complete the fields
  • 02 Click Sign Now and on the next screen add recipients and signature fields in SignNow
  • 03 Start your free trial to sign and send your doc
Sign Now

What a Personal Information Statement Is and When it’s Used

A Personal Information Statement is a standardized form that collects identifying, contact, employment, financial, and consent data about an individual for administrative, regulatory, or transactional purposes. Organizations use it to verify identity, run background checks, comply with regulatory requirements, or evaluate eligibility for services. The statement centralizes names, dates of birth, government ID numbers, addresses, employment history, and signature consent so receiving parties can rely on a consistent record while maintaining an audit trail and data protection controls.

Why a Clear Personal Information Statement Matters

A complete, accurate Personal Information Statement reduces processing delays, supports legal compliance, and creates a single, auditable source of truth for identity and eligibility decisions.

Why a Clear Personal Information Statement Matters

Who Typically Prepares or Requests the Statement

Organizations and individuals use Personal Information Statements across hiring, financial services, healthcare intake, legal onboarding, and real estate transactions.

  • Human resources teams collecting identity and employment history for onboarding and I-9 reconciliation.
  • Financial institutions and lenders verifying identity, income sources, and contact information for account opening.
  • Legal or compliance teams gathering information for client intake, conflict checks, and regulatory filings.

The form supports both internal recordkeeping and third-party verification when shared under appropriate consent and data protection rules.

Core Components Every Professional Personal Information Statement Should Include

A well-structured statement groups related data, collects explicit consent for processing, and provides clear signature and verification elements to support record retention and auditability.

Identifying Data

Full legal name, aliases, date of birth, and government ID numbers. Use exact legal names to match official records and avoid mismatches during verification checks.

Contact Details

Primary and alternate addresses, phone numbers, and email. Include residential street address and ZIP; P.O. boxes may be insufficient for legal service.

Employment History

Current employer, job title, start date, and recent employment dates. Provide employer contact info when background checks or verifications are required.

Financial Information

Bank account, tax ID, and income sources when relevant. Limit financial fields to what is necessary and document the lawful basis for collection.

Consent & Disclosures

Explicit statements authorizing data use, sharing, and background checks. For consumer-facing items, include ESIGN consumer disclosure where required.

Signature Block

Signature, typed name, and date plus authentication method. Record the signature method (electronic, RON, notarized) and capture an audit trail.

Step-by-Step: Filling Out the Personal Information Statement

Complete the form in order to avoid missing required fields; check each entry for spelling, formatting, and consistency with supporting documents.

  • 01
    1. Provide Identity: Enter full legal name and DOB with ID numbers.
  • 02
    2. Add Contact Info: Supply mailing address, phone, and email.
  • 03
    3. Confirm Employment: List current employer and job details.
  • 04
    4. Sign and Date: Execute signature using the required method.

How the Electronic Completion and Submission Flow Works

Digital processing follows a predictable flow: collect, verify, sign, and store. Each stage should capture metadata and an audit trail for future proof.

  • Upload Document: Sender uploads the form to the eSignature platform.
  • Assign Fields: Place required fields and validation rules.
  • Authenticate Signer: Use email, SMS, or stronger methods as needed.
  • Capture Audit Trail: System logs timestamps, IP, and actions.

Configuring an Online Completion Workflow

Set up validation, authentication, and routing to ensure completeness and compliance before the document is accepted.

Field Configuration
Full Name Required, autopopulate from profile if available
Date Format MM/DD/YYYY validation rule
ID Upload Required file type: PDF or image
Signer Auth Email or SMS two-factor authentication

Technical Requirements for Digital Signing and Submission

Confirm the platform supports secure upload, field validation, and audit-trail capture before collecting personal data.

  • File Formats: PDF, DOCX, HTML accepted
  • Authentication: Email, SMS, or stronger
  • Integrations: CRM and storage links

Data Handling, Security, and Compliance Considerations

Encryption: TLS 1.2/1.3; AES-256 at rest
Certifications: SOC 2 Type II; ISO 27001
HIPAA: BAA available when required
Audit Trails: Timestamped action logs
Access Controls: Role-based permissions
Accessibility: WCAG 2.0 Level AA

Risks and Potential Consequences of Inaccurate Statements

Verification Delays: Processing and onboarding setbacks
Regulatory Penalties: Fines or enforcement actions
Tax Impacts: Incorrect TINs trigger backup withholding
Contractual Voidance: Misstatements can void agreements
Privacy Breach: Unauthorized disclosure liabilities
Criminal Liability: False statements may carry criminal risk

Common Mistakes When Preparing a Personal Information Statement

  • Entering nicknames or abbreviations instead of full legal names, causing mismatches during identity verification.
  • Failing to use required date formats (MM/DD/YYYY) which can invalidate date-based eligibility checks.
  • Uploading low-quality ID images that cannot be verified, resulting in repeated requests and delays.
  • Neglecting to obtain explicit consent language for background checks or data sharing required by ESIGN or sector rules.

Real-World Examples of Use

These examples show how organizations use a Personal Information Statement to streamline verification and maintain compliance.

Optica Ventures LLC — Brian Fitzgibbons

Optica consolidated intake forms to a single statement to reduce back-and-forth with candidates.

  • They required consistent ID fields and signature consent.
  • The standardized form cut verification follow-ups and improved completion rates while preserving an auditable electronic trail for future reference.

Martin Properties — Tim Martin

A real estate operator moved tenant intake to a single online statement to avoid in-person paperwork.

  • They integrated photo ID upload and eSignature authentication.
  • This reduced move-in delays, ensured consistent ID capture for leases, and provided secure storage with clear retention policies.

eSignature Vendor Pricing and Feature Comparison for This Document

Basic pricing and common feature availability for representative eSignature vendors; select a vendor and plan that matches authentication, compliance, and volume requirements.

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 by vendor Varies by vendor Varies by vendor Varies by vendor
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 Varies Varies

Practical Tips for Accurate and Efficient Completion

Adopt simple validation rules, clear consent language, and consistent retention settings to reduce errors and support compliance.

Validate Key Fields Immediately
Use format checks for dates, ZIP codes, and TINs, and require confirmation for high-risk fields to prevent downstream processing errors.
Limit Data Collected
Collect only what is necessary for the immediate purpose to reduce privacy risk and simplify storage and deletion requirements.
Record Consent Clearly
Include explicit electronic consent text and capture method metadata (IP, timestamp) to satisfy ESIGN and regulatory disclosure expectations.
Secure Storage and Access
Encrypt records in transit and at rest, enforce role-based access, and document retention and deletion policies for audits.

Who Can Sign the Personal Information Statement

Individual

The subject of the statement signs to attest to the accuracy of personal data and to provide consent for verification and data sharing; for minors, a parent or guardian must sign on their behalf.

Authorized Representative

An agent or authorized representative (power of attorney, legal guardian, company officer) may sign when authority is documented; retain proof of authorization to avoid disputes.

Frequently Asked Questions and Troubleshooting

Common questions address identity mismatches, required attachments, signature methods, and retention practices; answers focus on practical remedies and regulatory considerations.


Need help? Contact support

be ready to get more
Join over 28 million airSlate SignNow users
Sign Now
Company
Forms
Pricing
Resources
Knowledge base
Other Products
© 2026 airSlate Inc. All rights reserved.