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Va 21-0538 june 2023 PDF Form: What You Should Know
I HEREBY CERTIFY that the information I have given on this form is true and correct to the best of my knowledge and belief. Page 3. 1. For the purpose of this form VA-21-0538, I certify that I am eligible to receive benefits under the provisions of the Veterans' Readjustment Benefits and Survivors' Benefits Improvement Act of 2006. 2. By certifying the information in item 1 of this form, I certify that I am the spouse, (husband or wife), of the dependent listed on the completed Veteran's Medical Information form. 3. By certifying the information in item 1 of this form I certify that both my personality trait and my dependent personality trait (that is, I don't live in a completely individualistically confined and isolated way) have existed since I was born. 4. By certifying the information in item 2 of this form I certify that I have not been separated from my dependent since I was born. If I had been separated, I can demonstrate it by a declaration of separation issued by a court or US Department of Homeland Security. 5. By certifying the information in item 3 of this form I certify that I am not married to any dependent listed on this form. If I did have a dependent, I can show I was widowed due to death or separation by having received a letter from an agency which notified me of such separation and of the date of my death or departure from the United States. 6. By certifying the information in item 4 of this form I certify that I am the (husband or wife/husband) of the dependent listed on this form. I hereby certify that (husband or wife), (husband/wife), (marriage to dependent, marriage to non-dependent), (unmarried dependent), and dependent all means the same (I'm not married to anyone).” VACATION REVERSE (VA Form 21-055) 1 Jul 1, 2023 — Use VA form 21-055 to verify the status of your dependents (spouse and children). We use this information to determine if you're eligible to PAST VERIFICATION OF DEPENDENTS 21-055 I HEREBY CERTIFY that the information I have given on this form is true and correct to the best of my knowledge and belief. Page 3.
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