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Get Special Rate Disability Pension Form

Pairment from service injuries or diseases constitutes fewer than 50 impairment points, I will not be held to this choice. Your full name (please print) Your signature Date PART E Legal representative s authority to act 17. Authority to act on behalf of the person making the choice (if the person is unable to sign due to physical or mental incapacity or is under a legal disability). Details of the person who is legally authorised to act on behalf of the person who is unable to sign this f.

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