Pension Fund Third-Party Consent Form
Please complete this form to authorize a third party to act on behalf of a pension fund member. All fields are required for consent purposes only.
Member's Full Name
*
First Name
Last Name
Member Reference or Account Number
*
Third Party's Full Name
*
First Name
Last Name
Relationship to Member
*
Please Select
Spouse/Partner
Child
Parent
Legal Representative
Other
Purpose of Authorization
*
Contact Email for Third Party
*
example@example.com
Contact Phone Number for Third Party
Please enter a valid phone number.
Format: (000) 000-0000.
Signature of Pension Fund Member
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: