Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your details in Section 1. This includes your name, claim number, date of birth, email address, address, and phone numbers. Ensure that all auto-filled fields are correct and complete. Verify your contact information for accuracy.
3. In Section 2, provide the details of the person you wish to authorize. Enter their full name, relationship to you, date of birth, email address (if applicable), postal address, business address (if applicable), and phone numbers. This person will be representative for your claims, so provide accurate information.
4. Move to Section 3 where you specify the authority granted. You can choose to authorize for specific claim(s) or all claims managed by ACC. If applicable, list any claim numbers you are referring to.
5. In Section 4, read and understand the declaration statements. By signing, you acknowledge that you authorize ACC to act on the instructions of the nominated person and understand that you can cancel this authority at any time. Sign and date the form at the bottom to indicate your agreement.
6. Once you have completed all sections and verified your information, save your changes. You can choose to download the form, print it for mailing, or share it as needed.

Complete your documents online easily and ensure your claims are managed properly.