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Your Annual Verification Status:
I certify that:
(Please check off ALL of the following statements)
1. I am aware that Lifeline is a federal government assistance program, that willfully making false statements to obtain Lifeline can result in fines, imprisonment, de-enrollment or being barred from Lifeline.
2. I currently participate in one or more of the Lifeline-qualifying public assistance programs or qualify for Lifeline based on household income.
3. I am aware that only eligible consumers may enroll in Lifeline. I am also Head of Household.
4. I am aware that only one Lifeline discount per household is allowed. If I currently receive Lifeline from another phone company, I will de-enroll from Lifeline from the other company or from Nexus/Reachout Wireless.
5. I am aware that I may not transfer my Lifeline service to anyone
6. I will notify Nexus/Reachout Wireless within 30 days if I no longer receive government assistance or meet the income-based qualification, or someone else in my household receives Lifeline.
7. I understand that if I move, I will need to provide Nexus/Reachout Wireless with my new address within 30 days or I may be de-enrolled from Lifeline.
8. I authorize Nexus/Reachout Wireless to verify my eligibility with, and release my personal information to, including social service agencies, and entities and databases that manage the Lifeline program, including the Universal Service Administrative Company.
9. I understand that providing false information to receive Lifeline benefits can result in fines, imprisonment or denial of benefits, and I certify under penalty of perjury that all the information I have provided is true and correct to the best of my knowledge.
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You need to check all boxes to continue. If you cannot legally check a box because it is not true, please contact us at 1-877-870-9222. Thank you.