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O. Box 7066 Camden SC 29021-7066 1-877-988-9378 Fax 1-855-831-7044 www. myTRICARE.com by PGBA Revised 7/12/2017 TRICARE is a registered trademark of the Department of Defense Defense Health Agency. I hereby ratify and confirm all that my said attorney-in-fact shall lawfully do or cause to be done by virtue of the power granted herein. In witness whereof I have hereunto set my hand this day of 20. SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 20 NOTARY PUBLIC IN AND FOR SEAL MY...

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