Representative Information [CET]

Representative Information is as follows. The required information is bold.

• Rep LastName

• Rep FirstName

  • Rep MI

  • Rep Suffix

  • Rep SSN

  • Rep EstateTaxID

  • Complete Rep Address

    • see address requirements

  • Rep Relationship

    • • valid relationship values (choose only one)

        • • Guardian/Admin

          • Other

          • Relative

A Representative is only required if the Claimant is deceased.