Establishing secure connection…Loading editor…Preparing document…

SS-4 Affidavit Form

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

SS-4 Affidavit Form

This Affidavit is made on by Affiant Name: whose principal mailing address is (hereinafter "Affiant"), and executed before Notary Public: .

RECITALS

WHEREAS, Affiant submitted an application identified as Form SS-4 (Application for Employer Identification Number) or otherwise sought assignment of an Employer Identification Number on ; and

WHEREAS, Affiant is the Responsible Party for the entity identified below and has knowledge of the facts and circumstances relating to the information provided in connection with the SS-4 submission; and

WHEREAS, Affiant is executing this sworn affidavit to attest to the truthfulness and accuracy of the information provided to support the SS-4 application and to confirm the identity and authority of the Responsible Party.

NOW, THEREFORE

In consideration of the foregoing recitals and intending to be legally bound, Affiant hereby states, represents and certifies as follows:

1. ENTITY IDENTIFICATION

2. RESPONSIBLE PARTY

3. REPRESENTATIONS AND CERTIFICATIONS

Affiant represents and certifies under penalty of perjury that the information provided in connection with the SS-4 application and in this Affidavit is true, correct and complete to the best of Affiant's knowledge and belief. Affiant further certifies that Affiant is authorized to submit and verify such information on behalf of the entity named above.

Affiant acknowledges that knowingly submitting false information in a matter within the jurisdiction of a federal agency may constitute a violation of applicable laws and may be punishable by fines or imprisonment.

4. AFFIRMATION

Affiant affirms that Affiant has provided all material facts relating to the SS-4 application, that any documents attached to or referenced by this Affidavit are true and authentic copies, and that Affiant will promptly notify the receiving authority of any material change to the facts stated herein.

5. INDEMNITY

Affiant agrees to indemnify, defend and hold harmless any recipient of this Affidavit from and against any claims, liabilities, costs or expenses (including reasonable attorneys' fees) arising from Affiant's breach of the representations herein or from any materially false statement made by Affiant in this Affidavit.

6. NOTICES

All notices, requests, demands and other communications required or permitted hereunder shall be in writing and shall be deemed to have been duly given when delivered personally or when deposited for delivery by certified mail, return receipt requested, or when sent by nationally recognized overnight courier service, to the addresses set forth above, or to such other address as a party may designate by written notice to the other parties.

7. AMENDMENT AND WAIVER

This Affidavit may be amended or modified only by a written instrument executed by Affiant and acknowledged by a Notary Public. No failure or delay by any party in exercising any right or remedy shall operate as a waiver of such right or remedy.

8. COUNTERPARTS

This Affidavit may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Signatures delivered by electronic copy shall be deemed original signatures for all purposes.

9. GOVERNING LAW

This Affidavit shall be governed by and construed in accordance with the laws of the state in which the Affiant's principal place of business is located, without regard to principles of conflicts of law.

10. ENTIRE AGREEMENT

This Affidavit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings, whether oral or written.

11. SEVERABILITY

If any provision of this Affidavit is held to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

12. ACKNOWLEDGMENT OF PENALTIES

Affiant acknowledges that false statements made knowingly and willfully in this Affidavit may subject Affiant to criminal penalties, including but not limited to penalties for perjury under applicable federal and state law.

ATTACHMENTS

NOTARY ACKNOWLEDGMENT

State of , County of .

On the day of in the year , before me personally appeared , who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument and acknowledged to me that he/she executed the same for the purposes therein contained.

WITNESS my hand and official seal this day of , .

Affiant Printed Name:

By:

Date:

Notary Public Printed Name:

By:

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 the SS-4 Affidavit Form is and when it’s used

The SS-4 Affidavit Form is a sworn statement used alongside IRS Form SS-4 (Application for Employer Identification Number) to confirm facts about an entity, a responsible party, or the authority of a third party submitting an EIN request. It typically records identity, date, legal entity name, and a statement of authorization under penalty of perjury. Organizations use an SS-4 Affidavit when additional proof of authority or identity is required by the IRS, banking partners, or third-party service providers to complete an EIN registration or to correct SS-4 information.

Why an SS-4 Affidavit Form matters for EIN requests

An affidavit provides a signed, notarized record that supports data on the SS-4 and helps reduce follow-up requests. It documents authority and identity under oath.

Why an SS-4 Affidavit Form matters for EIN requests

Who commonly completes an SS-4 Affidavit Form

Typical filers include business owners, incorporators, and third-party agents preparing an EIN application.

  • Small business owners filing for an EIN or correcting SS-4 details; often need notarized proof of identity and authority.
  • Third-party agents or CPAs submitting on behalf of clients; affidavit confirms the agent’s authority to act.
  • Banks and financial institutions requesting a sworn statement before opening accounts or accepting an EIN change.

The form is also used by banks, payroll vendors, and registration agents that require sworn confirmation of information.

Primary elements to include in a professional SS-4 Affidavit Form

A clear, complete affidavit reduces processing delays. Include identity, authority, dates, notarization, witness statements where required, and a statement of truth under penalty of perjury.

Header

Document title and affidavit date to establish context and effective time.

Declarant Identity

Full legal name, title or role, and government ID reference to tie the signer to the entity.

Entity Details

Legal business name, DBA (if any), and EIN or requested EIN information.

Statement of Authority

Concise language describing why the signer can act for the entity.

Oath or Affirmation

Penalty-of-perjury language and jurisdiction clause to support legal enforceability.

Notary Block

Notarial acknowledgement and any required witness lines for state-specific validation.

Required information typically requested on the affidavit

Legal name: Exact name on formation documents
Entity type: Corporation, LLC, partnership, sole proprietorship
Responsible party: Name and SSN or ITIN of the responsible individual
Mailing address: Street, city, state, ZIP
EIN reference: Existing or requested EIN number
Statement of authority: Role and basis for signing

Key legal risks and penalties for incorrect statements

False statement: Criminal liability under 18 U.S.C. §1001
Tax consequences: Incorrect EIN use may affect filings
Delay risk: IRS processing delays or rejection
Financial hold: Banks may refuse accounts or services
Identity mismatch: Account freezes or verification requests
Third-party risk: Vendor onboarding denied or deferred

Common mistakes to avoid when preparing the affidavit

  • Using a trade name instead of the entity’s exact legal name causes mismatches with IRS records and banking verification.
  • Omitting the responsible party’s SSN or ITIN can prevent the affidavit from proving identity for EIN assignment.
  • Failing to include clear authority language leaves the signer’s capacity ambiguous and invites follow-up documentation.
  • Neglecting notarization or required witness lines in jurisdictions that mandate them often voids the affidavit for official use.

Step-by-step: completing an SS-4 Affidavit Form

Follow a consistent sequence to reduce errors and speed acceptance.

  • 01
    Gather documents: Collect formation, ID, and prior EIN records
  • 02
    Draft affidavit: Enter exact names, dates, and authority language
  • 03
    Notarize: Sign in front of a notary or use approved RON
  • 04
    Submit: Attach to SS-4 or deliver to requesting party

Configuring an electronic workflow for affidavit completion

Set clear authentication and routing to ensure affidavit integrity and auditability.

Field Configuration
Authentication method Email link plus optional SMS code
File format PDF with embedded audit trail
Template reuse Use saved template for consistent fields
Routing order Sequential: preparer → signer → notary → recipient

Typical e-sign and submission flow for an affidavit

A reliable eSubmission combines identity checks, signature capture, notarization, and archival steps.

  • Upload document: Sender uploads PDF affidavit to the signing platform
  • Place fields: Sender adds signature, date, and ID fields as required
  • Signer authentication: Signer verifies identity via email, SMS, or stronger method
  • Notarization: Notary performs in-person or RON session and signs

Technical requirements for digital affidavit signing

Choose a platform that supports secure eSign, notarization, and audit trails.

  • File formats: PDF, Word DOCX supported
  • Integrations: Salesforce, NetSuite, Google Workspace
  • Security: TLS in transit; AES-256 at rest

Expected timelines for executing and delivering an affidavit with an SS-4

Timelines depend on delivery method and whether notarization or third-party review is required.

Online EIN issuance:

Often immediate when SS-4 is completed online

Fax submission:

IRS fax responses can take several business days

Mail submission:

Mail processing may take multiple weeks

Notarization scheduling:

Depends on notary or RON availability; allow 1–3 days

Third-party review:

Attorney or bank review may add 3–10 business days

Key milestones from affidavit drafting to final acceptance

A straightforward milestone sequence helps coordinate signers, notaries, and recipients efficiently.

01

Draft and validate

Prepare the affidavit and confirm names, EIN status, and authority

02

Sign and notarize

Execute in presence of notary or complete a compliant RON session

03

Attach to SS-4

Bundle affidavit with the SS-4 application or provide to the requesting party

04

Confirm acceptance

Get written confirmation from the IRS, bank, or vendor that the affidavit suffices

Practical tips for accurate, efficient affidavit completion

Follow these best practices to minimize rework, protect legal standing, and speed downstream acceptance.

Verify responsible party identity and numbers
Confirm the responsible party’s SSN or ITIN against government ID documents before inserting it into the affidavit. Mismatched identifiers commonly trigger verification requests and may cause account or filing delays that require time-consuming corrections.
Use exact legal entity names
Match the entity name on the affidavit exactly to state formation records and the SS-4 entry. Small spelling differences, omitted corporate designators, or inconsistent punctuation can cause banks and the IRS to reject or seek clarification.
Choose notarization method intentionally
If the receiving party accepts Remote Online Notarization, confirm the state allows RON and preserve audio-video recording per state rules. Otherwise use an in-person notary to avoid jurisdictional acceptance issues.
Keep signed originals and certified copies
Retain the original notarized affidavit plus a certified or scanned copy. Store records with secure access controls and export audit trails to satisfy regulatory or banking due diligence requirements.

Illustrative scenarios showing how the affidavit is applied

These case examples show typical contexts where an SS-4 Affidavit clarifies authority or identity.

Startup incorporating and banking

A newly formed LLC needs an EIN to open a bank account

  • The founder executes an affidavit confirming formation and authority
  • The notarized affidavit attached to the SS-4 satisfied the bank’s underwriting and enabled account opening within days while reducing follow-up requests.

CPA filing on client’s behalf

A CPA prepares an SS-4 for a client relocating operations

  • The client signs an affidavit authorizing the CPA to request an EIN
  • The affidavit documented the CPA’s authority and a notarized copy reduced additional identity verification steps from the receiving bank.

Comparing eSignature vendor pricing and basic feature availability

Cost and capability vary by vendor. signNow is listed first to show a representative starting price and feature set.

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 Yes, 7-day free trial No No No No
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about SS-4 Affidavit Forms

Answers to common questions about use, notarization, eSignature, and filing practices.


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.