COVID-19 Income Verification Sample Form

Updated 04/01/2020

This disclosure is intended as a template to be used to at early disclosure to inform applicants of their responsibility to inform the Bank of any negative change in employment or income. The Bank should tailor this form to its needs. It is important to remember that if you’re requiring an applicant to prove a loss of income associate with a current or former job, there are no federal forms associated with this. Individual states may have forms to help document change in earnings or loss of income. Consult with your Bank’s HR Department or Legal Counsel for additional guidance. The included form is intended as a template to be used to by applicant(s) and/or guarantor(s) when a negative change to income or employment has occurred. Verify with Bank Counsel or your HR Department that there are not additional required State forms in relation to proof of loss of income verification

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