Power of Attorney

First Name *

Last Name *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

Date of Birth

Occupation

Please attach a copy of your driver's license, BC Services Card or other photo ID

Click or drag a file to this area to upload.

Name of Appointed Attorney *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number

Date of Birth

Occupation

Appoint an Alternate Attorney?

Name of Appointed Attorney

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number

Date of Birth

Occupation

Any special rights or restrictions to Attorney:

Have you previously made a Power of Attorney?

Any other comments:

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