Fiduciary Appointment Form

Fiduciary Appointment Form
Please complete this form to appoint a fiduciary and specify the terms of their authority.
Principal's Full Name
First NameLast Name
Principal's Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Principal's Email Address
example@example.com
Principal's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fiduciary's Full Name
First NameLast Name
Fiduciary's Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Fiduciary's Email Address
example@example.com
Fiduciary's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship of Fiduciary to Principal
Appointment Date and Time
Scope of Fiduciary Authority (select all that apply)
Other (please specify)
Duration of Appointment
If you selected 'Specific Period', please enter the start and end dates
Additional Instructions or Special Provisions
Should be Empty: