Affidavit of Dependency
Declare under oath that a person relies on you for financial support and is your dependent. Commonly required by health insurance carriers and employers to verify dependent eligibility, by the IRS or benefits agencies to substantiate a claimed dependent, and by USCIS in immigration filings involving dependent relatives.
Prefer to fill in by hand?
Download a blank PDF template to print and complete manually.
Download Blank TemplateAffidavit of Dependency Affidavit — Frequently Asked Questions
What is an affidavit of dependency?
An affidavit of dependency is a notarized sworn statement declaring that a specific person — such as a child, parent, or other relative — relies on you for financial support. Insurers, employers, benefits agencies, and immigration authorities use it to verify that the person qualifies as your dependent.
What proof do I need to show someone is my dependent?
Along with a notarized affidavit, institutions commonly ask for supporting records such as a birth certificate showing the relationship, tax returns claiming the dependent, shared address documentation, and receipts or bank transfers showing regular support. Requirements vary by institution, so confirm what the requesting agency will accept.
How do I make a affidavit of dependency affidavit legally valid?
Fill in the affidavit of dependency affidavit, print it, and sign it in front of a Notary Public — do not sign beforehand. Bring a valid government-issued photo ID. Notaries are available at UPS Stores, banks, law offices, courthouses, and through online notarization services, and fees typically range from $2 to $25 per signature depending on your state.
Is this affidavit of dependency affidavit template free?
Yes. You can generate a completed affidavit of dependency affidavit PDF or download a blank printable template completely free, with no sign-up required. Your information is used only to generate the document and is not stored after the PDF is created.