This sworn affidavit confirms the financial dependency of a parent or parent-in-law on the policy holder for healthcare coverage. It includes the policy holder's name and identification details, the dependent's name and identification details, a statement that the dependent is financially reliant on the policy holder for care and support, the date, the policy holder's signature, and a section for authentication by a commissioner of oaths.
This sworn affidavit confirms the financial dependency of a parent or parent-in-law on the policy holder for healthcare coverage. It includes the policy holder's name and identification details, the dependent's name and identification details, a statement that the dependent is financially reliant on the policy holder for care and support, the date, the policy holder's signature, and a section for authentication by a commissioner of oaths.
This sworn affidavit confirms the financial dependency of a parent or parent-in-law on the policy holder for healthcare coverage. It includes the policy holder's name and identification details, the dependent's name and identification details, a statement that the dependent is financially reliant on the policy holder for care and support, the date, the policy holder's signature, and a section for authentication by a commissioner of oaths.