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VIRGINIA DEPARTMENT OF SOCIAL SERVICES (Model Form)SWORN STATEMENT OR AFFIRMATION FOR ADULT FACILITY EMPLOYEES To the Applicant: Section 63.21720 of the Code of Virginia requires that any person desiring
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How to fill out sworn statement or affirmation

01
To fill out a sworn statement or affirmation, follow these steps:
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Start by writing your full name and contact details at the top of the document.
03
Include the date on which you are making the statement.
04
Write a statement that clearly and concisely explains the facts or information you are affirming to be true.
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Make sure to include any relevant details, dates, and supporting evidence if available.
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Sign the statement at the bottom and include your printed name and signature.
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If required, have the statement witnessed by a notary public or authorized person.

Who needs sworn statement or affirmation?

01
Sworn statements or affirmations are often required in legal and official matters. The following individuals or entities may need to provide a sworn statement:
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- Witnesses in court cases
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- Individuals applying for certain licenses or permits
04
- Participants in government investigations or hearings
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- Contractors or vendors for government contracts
06
- Insurance claimants
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- Employees involved in workplace disputes or investigations
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- Individuals making legal declarations or affidavits
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A sworn statement or affirmation is a legal document where an individual states that the information provided is true to the best of their knowledge and belief.
Individuals who are required to provide a formal declaration of facts to a court or other authority.
Fill in the required information accurately and honestly, then sign and date the document in the presence of a notary public or other authorized official.
The purpose is to ensure that individuals provide truthful and accurate information in legal proceedings or dealings.
Key personal details and a statement attesting to the truthfulness of the information provided.
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