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Personal Representative Appointment
I,
(Please Print)do hereby appoint
(Please Print)as my personal representative to act on my behalf in the matters of health insurance with
UnitedHealthcare StudentResources.
I
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What is as my personal representative?
As your personal representative, you act on behalf of someone who has authorized you to make decisions on their behalf.
Who is required to file as my personal representative?
A person designated as a personal representative may be required to file if they have been given authority to act on someone else's behalf.
How to fill out as my personal representative?
To fill out as a personal representative, you will need to provide information about the person you are representing and any decisions or actions you are authorized to make.
What is the purpose of as my personal representative?
The purpose of a personal representative is to ensure that someone's wishes are carried out when they are unable to make decisions themselves.
What information must be reported on as my personal representative?
You must report information about the person you are representing, the decisions you are authorized to make, and any actions you have taken on their behalf.
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