Recipient Information Submission Form

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The information collected on this form will be used solely for the purpose of  

verification of balances to be paid and payment submission on behalf of recipient.

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As a recipient of financial assistance from Art of Life Foundation, Inc. I attest to the following:

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• I agree to provide the required information in order to receive financial assistance.  

• The information provided is said to be accurate to the best of my knowledge.

• I understand that Art of Life Foundation, Inc. will issue payment directly to the companies for the verified balance due.

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