Veterans Benefits Third-Party Authorization Form
Complete this form to authorize a third party to communicate with veterans benefits representatives on your behalf.
Veteran's Full Name
*
First Name
Last Name
Veteran's Email Address
*
example@example.com
Veteran's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Third Party Full Name
*
First Name
Last Name
Relationship of Third Party to Veteran
*
Please Select
Family Member
Friend
Legal Representative
Caregiver
Other
Third Party Email Address
example@example.com
Third Party Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Authorization Statement
*
Veteran's Signature
*
Submit Authorization
Submit Authorization
Should be Empty: