Is an electronic signature legally valid?

Yes. Electronic signatures are legally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and reproducible retention are satisfied.

When is notarization required?

Notarization is required only when the receiving party or state law mandates it, for example for certain acknowledgements or jurisdictional recording—check the recipient’s instructions and state rules.

How do I correct errors after submission?

Request a corrected form or amendment from the issuer; if a signature is affected, a re-signed corrected form is typically required to replace the earlier record.

Who should sign the form?

The individual to whom the information pertains must sign. An authorized representative may sign only when authority is documented and permitted by the receiving party.

How long should the form be stored?

Retain per the document’s purpose and applicable rules—IRS generally three years, HIPAA six years for PHI, and longer when industry or state law requires it.

Can I revoke or withdraw consent?

Consent withdrawal procedures should be described in the form; organizations must follow ESIGN consumer disclosure rules for consumer-facing records when accepting or revoking electronic consent.

Electronic Signature
Templates
Personal
Personal Information Statement Form

Personal Information Statement Form

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

PERSONAL INFORMATION STATEMENT

The undersigned provides the following personal information for identification, evaluation, and administrative purposes. The information furnished will be relied upon in making determinations required by the receiving party. I certify that the information provided is true, complete, and correct to the best of my knowledge. I understand that intentional omissions or false statements may subject me to civil or criminal penalties.

1. Personal Identification

Full Legal Name Other Names Used (maiden, aliases)

Date of Birth: Place of Birth:

Social Security Number or Tax ID

2. Contact Information

Current Residence Address

Length of Residence (years): Phone (Primary): Email:

3. Citizenship and Status

Citizenship: U.S. Citizen Non-U.S. Citizen

If not U.S. citizen, immigration status or visa type

4. Marital and Household

Marital Status: Single Married Divorced Widowed

Spouse or Partner Full Name (if applicable) Number of Dependents and Ages

5. Employment and Income

Current Employer Employer Address

Position/Title: Start Date:

Gross Monthly Income Other Income (source and monthly amount)

6. Assets

Real Estate (address and estimated market value) Bank Accounts (institution and approximate balance) Vehicles / Major Personal Property Estimated Total Assets

7. Liabilities

Primary Mortgage Lender: Balance: Monthly Payment:

Other Loans, Credit Cards and Obligations (list creditor, balance, monthly payment) Estimated Total Liabilities

8. Emergency Contact and References

Emergency Contact Name

Relationship: Phone: Address:

Reference (Name, Relationship, Phone)

9. Background Declarations

Have you ever filed for bankruptcy? Yes No

Are there any judgments, liens, or pending civil actions against you? Yes No

Have you ever been convicted of a crime (excluding minor traffic offenses)? Yes No

If yes to any of the above, provide explanation with dates and disposition

10. Certification and Authorization

I certify under penalty of perjury under the laws of the applicable jurisdiction that the foregoing statements and information supplied in this Personal Information Statement are true, correct and complete. I authorize the recipient of this statement to verify the accuracy of the information provided, to obtain consumer and investigative reports, and to contact employers, educational institutions, references, and credit reporting agencies as necessary for verification. I agree to provide additional documentation upon request to substantiate representations made herein.

I understand that this Personal Information Statement is furnished for the purpose stated and shall be valid for reasonable administrative use. I release from liability any party who provides information in good faith pursuant to this authorization.

Authorization to Obtain Records: I authorize verification and release of records as described above.

Notary / Witness Information (If applicable)

If this statement is to be notarized, attach the appropriate notarization. Provide notary name and commission information below for record-keeping.

Notary Name (print)

Commission Number: Commission Expiration:

Signature and Acknowledgment

Printed Name:

Signature:

Date:

By signing above, I confirm that I have read and understood the statements and authorizations contained in this Personal Information Statement and that the information provided is accurate to the best of my knowledge.

What the Personal Information Statement Form Is

A Personal Information Statement Form collects standardized contact, identification, employment, and financial background details from an individual for administrative, vetting, or recordkeeping purposes. It consolidates name, address, date of birth, government ID numbers, emergency contact, employment history, and optional financial disclosures into a single, signed record to support hiring, contracting, benefits enrollment, or background review workflows. When used with electronic signature and audit-trail tools, the form creates a reproducible, time-stamped record suitable for retention and downstream verification by HR, legal, compliance, or financial teams.

Why a Clear Personal Information Statement Matters

A consistent Personal Information Statement reduces errors, centralizes key identity and contact data, and creates an auditable record for compliance and operational use. Accurate forms help avoid delays in onboarding, benefits processing, and regulatory checks.

Who Typically Completes and Relies on This Form

Organizations use this form to collect identity and contact details from employees, applicants, contractors, or clients before starting a business relationship.

Human resources teams and hiring managers who require verified contact and ID details for onboarding and payroll setup.
Finance and accounts payable for vendor onboarding, ACH setup, and tax-record reconciliation.
Legal, compliance, and security teams conducting background checks, identity verification, or access provisioning.

Proper completion and retention maintain continuity across HR, finance, and compliance functions and reduce rework when data is needed later.

Core Sections to Include in a Professional Form

A robust Personal Information Statement is organized into clear sections that map to common administrative and legal needs, ensuring each data element has an explicit purpose and format requirement.

Identification

Collect full legal name, any aliases, date of birth, and government ID type and number; specify format and instruct the signer to match government ID to avoid verification delays.

Contact Details

Request street address, city, state, ZIP, primary phone, and email; explain that a P.O. box may be insufficient for legal service or identity proofing in some processes.

Employment

Capture current employer name, job title, supervisor contact, start date, and employment status so reviewers can confirm eligibility for benefits and access permissions.

Financial/Tax

Include taxpayer identification (e.g., SSN/TIN) and payment routing details only when required; warn about secure transmission and backup withholding consequences for incorrect TINs.

Emergency Contact

Ask for name, relationship, and two contact methods so the organization can act promptly if an urgent situation arises.

Consent & Certification

Provide a signer declaration for accuracy, data-sharing consent where needed, and an explicit signature block indicating legal attestation and date of signing.

Essential Data Elements and Security Notes

Full Name: Given and family names

Date of Birth: MM/DD/YYYY format

Government ID: ID type and number

Contact Address: Street, city, state, ZIP

Tax Identifier: SSN or TIN

Signature: Signed and dated

Step-by-Step: Completing the Form

Follow these sequential steps to fill, review, and submit a Personal Information Statement correctly.

01

Gather documents: Have ID and tax documents ready
02

Enter fields: Complete each field per instructions
03

Verify accuracy: Review for typos and format mistakes
04

Sign and submit: Apply signature and send to recipient

How Submission and Routing Typically Work

A standard routing flow ensures the form reaches relevant teams with audit data preserved for compliance and recordkeeping.

Upload: Sender uploads the completed form
Assign: Route to HR, finance, or compliance
Approve: Designated approver reviews entries
Archive: Store with retention metadata

Typical Digital Workflow Settings

Configure fields and routing rules to minimize manual steps and preserve a complete audit trail for each submission.

Field	Configuration
Identity Fields	Required, masked for SSN
Signature Field	Required, timestamped
Routing Rule	Send to HR then finance
Retention Tag	Attach 7-year retention

Digital Signing and Platform Capabilities

Choose a platform that provides secure signing, audit trails, and configurable authentication appropriate for the sensitivity of the data.

File types: PDF, DOCX supported
Integrations: Connects to HRIS and storage
Security: TLS and AES encryption

Verify the provider supports ESIGN/UETA compliance, HIPAA BAA if handling PHI, and offers authentication options (email, SMS, KBA) to match your risk profile.

Timing and Typical Deadlines to Keep in Mind

Some elements tied to the form have time-sensitive deadlines; track what must be provided or retained to avoid compliance gaps.

Form Provision:

Provide upon request; no universal filing deadline

Tax Identifiers:

Submit corrected TINs promptly to avoid backup withholding

Notarization Window:

Complete any required notarization before submission deadlines set by the receiving party

Background Checks:

Initiate within employer-specified onboarding windows to prevent start-date delays

Record Retention:

Begin retention clock on document execution date

Key Risks If the Form Is Incorrect or Incomplete

Incorrect TIN: 24% backup withholding

Late 1099: $60–$330 per form

I-9 Violations: $281–$2,789 per violation

Privacy Breach: HIPAA penalties and remediation costs

Invalid Signature: Document may be unenforceable

Retention Failure: Discovery and regulatory exposure

Common Pitfalls to Avoid When Preparing the Form

Entering nicknames or initials rather than the full legal name causes mismatches during identity verification and background checks.
Using inconsistent address formats or only a P.O. box can invalidate residency-dependent processes and slow verification.
Failing to secure or mask SSNs exposes sensitive data and increases breach risk if the form is stored insecurely.
Not obtaining clear consent or failing to present the required ESIGN consumer disclosure for consumer-facing records can affect legal enforceability.

eSignature Pricing and Feature Snapshot for Form Processing

Compare common eSignature vendor starting prices and feature availability relevant to Personal Information Statement workflows; signNow is listed first per vendor ordering 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 free trial	Yes, trial	Yes, trial	Yes, limited free plan	Yes, limited free plan
Bulk Send	Yes (Business Premium+)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently Asked Questions About the Personal Information Statement Form

Answers to common questions about validity, signing, notarization, updates, storage, and revocation for the Personal Information Statement Form.

Need help? Contact support

Is an electronic signature legally valid?
Yes. Electronic signatures are legally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and reproducible retention are satisfied.
When is notarization required?
Notarization is required only when the receiving party or state law mandates it, for example for certain acknowledgements or jurisdictional recording—check the recipient’s instructions and state rules.
How do I correct errors after submission?
Request a corrected form or amendment from the issuer; if a signature is affected, a re-signed corrected form is typically required to replace the earlier record.
Who should sign the form?
The individual to whom the information pertains must sign. An authorized representative may sign only when authority is documented and permitted by the receiving party.
How long should the form be stored?
Retain per the document’s purpose and applicable rules—IRS generally three years, HIPAA six years for PHI, and longer when industry or state law requires it.
Can I revoke or withdraw consent?
Consent withdrawal procedures should be described in the form; organizations must follow ESIGN consumer disclosure rules for consumer-facing records when accepting or revoking electronic consent.

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