Lawyer Attestation letter
I am： A Certified Public Accountant （CPA）， or An Attorney
Name： _______________________________________________________________________
Firm Name： __________________________________________________________________
Firm Address： ________________________________________________________________
Telephone Number： ___________________________________________________________
Professional License and/or Association Number（s）： _________________________________
This letter of attestation is being provided on behalf of the following business entity：
Group's Name： ________________________________________________________________
Group's Address： ______________________________________________________________
Group's Telephone Number： ____________________________________________________
Group Officer's Name （from whom you received the written documentation reviewed in connection with this letter of attestation）： __________________________________________
This group is a new business， which started on __________________ and will be filing tax documents， which will be sent to you at a future date.
I certify that this group has a New York situs， and is a：
> Sole Proprietorship, and the proprietor works a minimum of 20 hours per week.
> Partnership
> Corporation
> Limited Liability Company (LLC)
> S-Corp
> Other Type of Business Entity (explain) ___________________________________________
（Please attach copies of supporting documentation）
The following employees of this firm began working for this company on the following dates， and are working full-time （20 hours or more per week）， and will be shown on future tax documents which will be provided to you.
Name Start Date Name Start Date
________________________ ________ ___________________ _________
________________________ ________ ___________________ _________
I hereby certify that the information I have stated above are true statements based on documentation provided to me. I hereby make this certification to induce X Company to offer health insurance coverage to this group based upon the information contained in my certification. I understand that X Company will retain this letter and any attached materials without regard to the acceptance or non-acceptance of the group‘s application for coverage.
Signature：_________________
Date： ____________________