Free Pension Power of Attorney Form

Please complete this form to authorize someone to manage pension-related matters on your behalf.
Grantor Information
Name
Address
Phone Number
Social Security Number (optional)
Authorized Representative Information
Name
Address
Phone Number
Relationship to Grantor
Authorization Details
I,
Powers Granted
Check all that apply:
Accessing and managing my pension account(s)
Submitting and following up on pension applications
Handling pension withdrawals or disbursements
Updating beneficiary or account details
Communicating with pension providers or agencies
Effective Date
Termination Date
This power of attorney will remain in effect until:
By signing below, I confirm that I understand and agree to the terms of this authorization.
Name:
Date:
Name:
Date:
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