Secondary Advocate 1. Mr. Mrs. Ms. Last 4 Digits of SSN: Address: City: State: Zip: Cell Phone: Home Phone: Email Address: Work Phone: *Relationship to Beneficiary: Permission to receive financial account information? a) Immediately upon funding? ☐ YES ☐ NO b) If requested in the future? ☐ YES ☐ NO If YES to a) or b), indicate financial account access preference: ☐Online ☐Mail
Appears in 8 contracts
Samples: Third Party Pooled Special Needs Trust Joinder Agreement, Third Party Pooled Special Needs Trust Joinder Agreement, Third Party Pooled Special Needs Trust Joinder Agreement
Secondary Advocate 1. Mr. Mrs. Ms. Last 4 Digits of SSN: Address: City: State: Zip: Cell Phone: Home Phone: Email Address: Work Cell Phone: *Relationship to Beneficiary: Permission to receive financial account information? a) Immediately upon funding? ☐ YES ☐ NO b) If requested in the future? ☐ YES ☐ NO If YES to a) or b), indicate financial account access preference: ☐Online / Internet ☐Mail
Appears in 1 contract
Samples: First Party Pooled Special Needs Trust Joinder Agreement
