Power of Attorney

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Your Information – Step 1 of 2

How did you hear about us?

Name

First

Last

Are you contacting us

As a Private Person
On behalf of a Company

Home Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Employer's Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Company Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Your Contact Information as a Company Representative

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile Phone

Business Phone

Occupation

Photo Id Serial number

Digital copy of your Identification document

Click or drag files to this area to upload. You can upload up to 6 files.

Driver’s Licence, Birth Certificate, Passport, etc. Accepted file types are .jpg, .png, .pdf

Main Trustee

First

Last

Main Trustee Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Secondary Trustee

Add Secondary Trustee

Secondary Trustee Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Alternate Trustee

First

Last

In case the Main is not able to act as a trustee

Alternate Trustee Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country