Military Agent Letter of Authorization Form
Complete this Military Agent Letter of Authorization Form to designate a military agent for specified administrative matters.
Authorizer's Full Name
*
First Name
Last Name
Authorizer's Rank
*
Authorizer's Unit or Organization
*
Authorizer's Contact Email
*
example@example.com
Designated Agent's Full Name
*
First Name
Last Name
Designated Agent's Rank
*
Relationship of Agent to Authorizer
*
Please Select
Spouse
Parent
Sibling
Friend
Legal Representative
Other
Scope of Authorization (Describe the specific administrative matters the agent is authorized to handle)
*
Authorization Period Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Authorization Period End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Authorization Statement: I hereby authorize the above-named agent to act on my behalf for the specified military-related administrative matters during the stated period.
Signature of Authorizer
*
Submit Authorization
Submit Authorization
Should be Empty: