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.
  Date: ____________________