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Stated Income Verification Form

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STATED INCOME VERIFICATION FORM

WHEREAS

WHEREAS, Client Name: (the "Applicant") has applied to Company Name: (the "Verifier") for credit or other financial accommodation, and

WHEREAS, Applicant seeks to have Applicant's income stated for underwriting or decisioning purposes and has requested that Verifier rely on Applicant's representations of income without immediate delivery of full traditional documentation; and

WHEREAS, Verifier agrees to perform income verification activities subject to the terms and conditions set forth in this document and to rely on the representations and authorizations provided by Applicant.

APPLICANT INFORMATION

BUSINESS / SELF-EMPLOYMENT INFORMATION

Entity Type:

Business Start Date:

INCOME DECLARATION

Applicant hereby states the following income information is true and correct to the best of Applicant's knowledge:

Income Sources (select all that apply):

Income Period Verified: From to

SUPPORTING DOCUMENTS

Applicant shall provide or authorize access to the items checked below. Verifier may rely on these items and on Applicant's representations.

SCOPE OF WORK

Verifier will perform income verification services limited to: confirming receipt of funds shown on provided bank documentation, reviewing profit and loss summaries, and contacting third parties solely to confirm employment or income statements where authorized below. Verifier does not provide legal, tax or accounting advice and will not prepare financial statements.

PAYMENT TERMS

Applicant agrees to pay Verifier the fee described below for services rendered in connection with this stated income verification.

TERM AND TERMINATION

This Agreement commences on and continues until unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for convenience with prior written notice to the other party delivered at least days in advance.

CONFIDENTIALITY

All non-public financial information, business records, and other materials provided by Applicant to Verifier in connection with this verification shall be treated as confidential and shall not be disclosed by Verifier except (a) as compelled by law or regulation, (b) to third parties engaged to assist in the verification process under duties of confidentiality, or (c) with Applicant's prior written consent.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This Agreement constitutes the entire agreement between Applicant and Verifier with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings of the parties, whether written or oral. Any amendment or modification must be in writing and signed by both parties.

REPRESENTATIONS, WARRANTIES AND CERTIFICATION

Applicant represents and warrants that all information provided in this form and in any accompanying documentation is true, complete and accurate. Applicant understands that Verifier will rely on these representations in performing verification services and that intentional misrepresentation may constitute fraud and may result in civil and criminal penalties, including denial of the requested credit and notification to other parties as required by law.

Applicant certifies under penalty of perjury that the stated income amounts are true and accurate to the best of Applicant's knowledge.

AUTHORIZATION TO OBTAIN AND VERIFY INFORMATION

Applicant authorizes Verifier and its agents to obtain and verify information from banks, employers, trade references, tax authorities, and other third parties as necessary to confirm the income and documentation identified herein. Applicant releases such third parties from liability for furnishing such information to Verifier.

MISCELLANEOUS PROVISIONS

If any provision of this Agreement is determined to be invalid or unenforceable, the remainder of this Agreement will not be affected and shall remain in full force and effect. Headings are for convenience only and do not affect interpretation.

DISPUTE RESOLUTION

Parties agree that any dispute arising out of or relating to this Agreement will be subject to the exclusive jurisdiction of the courts located in the county of the governing law state identified above, unless otherwise agreed in writing.

SIGNATURES

Applicant Printed Name:

By:

Date:

Verifier Printed Name:

By:

Date:

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What the Stated Income Verification Form is and when it’s used

The Stated Income Verification Form is a lender-facing declaration by an applicant specifying gross income without supplying full third-party pay documentation. Commonly used for self-employed borrowers or gig-economy applicants, it records declared income, income source, employment details, and signer attestations. Lenders use it as part of underwriting, risk assessment, or product eligibility when alternative documentation is unavailable or impractical. The form itself is a record of the applicant’s representation and typically accompanies credit checks, bank statements, or business ledgers when underwriters accept partial verification.

Why this form matters for lenders and borrowers

A clear Stated Income Verification Form reduces processing friction by standardizing applicant declarations, supports faster underwriting for nontraditional earners, and creates an auditable record of the applicant’s representation. When correctly completed and retained, it helps document the lender’s due diligence and risk decision.

Why this form matters for lenders and borrowers

Who commonly completes or reviews this form

Typical participants include lenders, brokers, and borrowers where conventional income documentation is limited.

  • Mortgage brokers and loan officers who intake applications and assemble underwriting packages.
  • Underwriters and credit analysts who evaluate declared income against alternative evidence.
  • Self-employed or gig-economy borrowers who lack standard paystubs or W-2 forms.

The form is a working record: lenders rely on it for decisioning and borrowers must ensure accurate, signed statements.

Essential parts of a professional Stated Income Verification Form

A complete form clearly identifies parties, shows the income declaration and period, records supporting evidence references, includes an attestation and signature block, and provides fields for lender review notes and authentication steps.

Identification

Full legal name, date of birth, and government ID reference to tie the income claim to a verified identity and reduce mismatches during underwriting.

Income detail

Declared gross income amount, frequency (monthly/annual), and the period covered; specify whether figure is pre-tax or net to avoid misinterpretation.

Income source

Describe primary income sources (self-employment, contract work, rental income) and attach or reference bank statements, invoices, or business ledgers where available.

Attestation

A signed statement where the borrower affirms the accuracy of the declared income under penalty of perjury or civil liability where applicable.

Underwriter notes

Fields for lender verification steps, results, conditional approval remarks, and required follow-up items for file completeness.

Authentication

Signature block with date and method of signing (wet signature, e-signature, or notarization) and space to record notarization or ID-check details.

Core fields required on the form

Borrower name: Full legal name
Tax identifier: SSN or TIN
Declared income: Gross amount
Income period: Monthly or annual
Employment details: Employer or business name
Signature: Signed and dated

Step-by-step: completing the Stated Income Verification Form

Follow a concise sequence to reduce errors and speed underwriting: collect identity evidence, enter income details, add supporting references, and sign using an approved method.

  • 01
    Gather evidence: Collect bank statements, invoices, or ledgers
  • 02
    Enter details: Fill name, SSN/TIN, income amount, and period
  • 03
    Document sources: Reference or attach supporting documents
  • 04
    Sign and date: Use authorized signer method and record it

Configuring an online form workflow

Set up field behaviors and signer authentication to match lender risk controls and regulatory requirements before sending the form for signature.

Field Configuration
Authentication Email link or SMS code; stronger KBA for higher risk
Conditional fields Show supporting-document fields when self-employed selected
Date format MM/DD/YYYY enforced
Template locking Lock key fields after completion to prevent edits

Where to send or file the completed form

After completion, route the form to underwriting, attach it to the loan file, and retain an immutable copy for compliance and audit.

  • Send to lender: Email or upload to lender portal
  • Attach to LOS: Upload into Loan Origination System records
  • Include evidence: Attach bank statements or invoices
  • Retain signed copy: Store for required retention period

How to share and distribute the form securely

Choose distribution channels that preserve the signature audit trail, support attachments, and meet authentication needs.

  • Email delivery: Send secure signing links via email
  • Document systems: Integrate with LOS or CRM platforms
  • Cloud storage: Archive final PDFs in secure cloud

Use platforms that generate an audit trail and store tamper-evident copies to support future review and compliance checks.

Typical timelines and processing expectations

Timelines vary by lender product and jurisdiction; use the following as general expectations to manage applicant communications and file completeness.

At application:

Provide stated income form with loan application

Underwriter review:

Expect 3–5 business days for verification

Pre-closing follow-up:

Respond to lender requests within 48–72 hours

Notarization timing:

If required, complete notarization before closing

Record retention:

Retain signed form per regulatory schedule

Common preparation mistakes to avoid

  • Entering inconsistent name or TIN between the form and government ID leads to verification delays and re-execution requests.
  • Stating gross income without specifying period (monthly vs annual) causes underwriting miscalculations and may lead to inconsistent debt-to-income ratios.
  • Failing to attach or reference supporting bank statements or invoices weakens the file and increases the likelihood of manual underwriting questions.
  • Using informal signatures or unsigned fields prevents acceptance; e-signature methods must capture intent and attribution to be valid.

Consequences and legal risks of incorrect declarations

Application denial: Lender may decline the loan
Loan rescission: Originator may rescind if fraud suspected
Civil liability: Potential borrower liability for misrepresentation
Repurchase risk: Secondary market repurchase obligations for lender
Regulatory review: Regulator inquiry if pattern of misstatements
Fraud investigation: Criminal exposure in intentional falsification cases

How Stated Income differs from Verified Income documentation

A concise comparison highlights documentation, lender reliance, and typical verification requirements used by underwriters.

Criteria Stated Income Verified Income
Documentation Required self-attested paystubs or tax returns
Lender risk higher lower
Use case nontraditional earners traditional employees
Verification alternative evidence third-party verification

Download, export, and save: file formats and audit preservation

Preserve the signed record in secure, tamper-evident formats and keep an audit trail showing signature events, timestamps, and signer authentication.

PDF export

Save a final PDF/A copy that embeds the signature audit trail and attachments for long-term storage and court-admissible evidence.

DOCX backup

Keep an editable DOCX working copy for internal review, but archive the signed PDF as the authoritative file.

CSV indexes

Export metadata (signer, date, document ID) to CSV for batch recordkeeping and regulatory reporting purposes.

Cloud archive

Store signed documents in a secure cloud repository with encryption and role-based access for compliance and ease of retrieval.

Real-world examples of usage in operations

These examples show how organizations apply electronic form workflows to handle income declarations where traditional documentation is limited.

Martin Properties

Martin Properties implemented online tenant paperwork including income declarations for remote closings.

  • The system enabled mobile signing and secure uploads.
  • "I can process and execute all of these documents online with 100% compliance and built-in security," said Tim Martin, Founder, describing faster turnaround and consistent audit trails.

Optica Ventures

A small investment firm standardized applicant income statements into a single electronic form.

  • That reduced back-and-forth for missing details.
  • Brian Fitzgibbons, COO, noted the interface was simple for both staff and customers while improving file completeness and traceability.

Who is permitted to sign the form

Borrower

The borrower or individual claiming the income must sign. Signatures should match the legal name and be authenticated to tie the declaration to the correct person for underwriting.

Authorized rep

An authorized representative (power of attorney or corporate officer) may sign when documented authority exists; include proof of authority and note the representative role on the form.

Notarization and witness steps for authenticated signing

When notarization or witnesses are required, follow a clear, sequential process to ensure proper identity proofing and record capture.

01

Prepare the form

Complete all fillable fields before attending notarization

02

Bring ID

Signer presents government-issued photo ID to notary

03

Sign before notary

Signer executes signature in notary presence

04

Witness signatures

Add witness signatures where the state requires them

05

Notary acknowledgment

Notary completes acknowledgement block and seal

06

RON procedures

For remote notarization, record audio-video and retain session

07

Record journal

Notary records journal entry per state rules

08

Deliver to lender

Submit the notarized copy with the loan file

Typical eSignature pricing and capability snapshot for signing forms

Comparing basic pricing and common capabilities can help select an eSignature provider that meets authentication, audit, and volume needs for Stated Income Verification Forms.

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, no credit card Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes (Premium plan) Varies by plan Varies by plan Varies by plan Varies by plan
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes (BAA available) Varies by plan Varies by plan Varies by plan Varies by plan
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Frequently asked questions about completing and submitting the form

Answers to common user issues covering e-signing, notarization, corrections, and retention for Stated Income Verification Forms.


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