Get Authorization Of Representative

The Authorization of Representative form enables seniors to delegate a representative for managing their Alberta Seniors Benefits and Special Needs Assistance. This guide provides step-by-step instructions on how to fill out the form online, ensuring that your information is accurately submitted.

Follow the steps to complete the Authorization of Representative form.

1. Click ‘Get Form’ button to access the Authorization of Representative form and open it in the editor.
2. Enter the senior’s Personal Health Number (PHN) in the appropriate field.
3. Fill out the senior’s name, including their current address, city, and province, ensuring all details are accurate.
4. Provide the name of the authorized representative, including their address, city, province, postal code, and phone number.
5. Check 'Yes' if the senior wishes for their mail from Seniors Services to be directed to the representative’s address; otherwise, check 'No'.
6. Choose one authorization option by selecting either 'All my rights under the Freedom of Information and Protection of Privacy Act' or 'My right to access all my files containing personal information in all categories of personal information.'
7. The senior must sign and date the form in the designated area.
8. A witness, who is not the representative, must sign the form in the appropriate section to verify the senior’s signature.
9. Once all sections are completed, make sure to save changes, download, print, or share the form as necessary.

Complete and submit your Authorization of Representative form online today.