[Your Full Name / Business Name]
[Business Address]
[City, State, ZIP]
[Phone] | [Email]
[Website (Optional)]
Date: [Date]
To: [Requesting Party / Agency / Landlord / Bank Name]
[Address]
[City, State, ZIP]
Subject: Self-Employment Income Verification – [Your Full Name / Business Name]
1. Business and Self-Employment Details
1.1 Business Legal Name: [Business Name]
1.2 Business Type/Industry: [Industry]
1.3 Your Role/Title: [Owner / Sole proprietor / Partner / Contractor]
1.4 Self-Employed Since: [Month/Year]
1.5 Business Address: [Address]
1.6 Tax ID (Optional): [EIN/ID] (share only if necessary)
2. Income Summary
2.1 Income Period Covered: From [Start Date] to [End Date].
2.2 Gross Income (Optional): $[Amount] for the period / $[Amount] average per month.
2.3 Net Income (Optional): $[Amount] for the period / $[Amount] average per month.
2.4 Income Stability Note (Optional): My income is ☐ consistent ☐ seasonal ☐ variable based on projects/clients.
3. Supporting Documents (Recommended)
3.1 Attached or available upon request (select as applicable):
-
☐ Recent tax return(s) (Form [__])
-
☐ Profit and loss statement
-
☐ Bank statements for [__] months
-
☐ Client invoices/contracts
-
☐ 1099 forms (if applicable)
-
☐ Business license/registration
-
☐ Other: [List]
☐ Recent tax return(s) (Form [__])
☐ Profit and loss statement
☐ Bank statements for [__] months
☐ Client invoices/contracts
☐ 1099 forms (if applicable)
☐ Business license/registration
☐ Other: [List]
4. Statement of Truth
4.1 I declare that the information provided in this letter is true and correct to the best of my knowledge. This letter is provided for verification purposes only.
Sincerely,
[Your Full Name]
[Business Name]
Signatures
Self-Employed Individual: [Full Name]
Date: [Date]
Signature: ___________________________
Accountant / Tax Preparer Verification (Optional)
Accountant/Preparer Name: [Name]
Firm Name: [Firm]
Phone/Email: [Contact]
License/Designation (Optional): [CPA/EA/Other]
Statement (Optional): I have reviewed financial records provided to me and confirm the income information above is consistent with those records, to the extent reviewed.
Date: [Date]
Signature: ___________________________