Fillable Online Designated Personal Representative Form Fax Email Print
Designated Representative Form. You can use our electronic. Web to designate a representative, you must fill out and submit both of the forms below to the wtc health program.
The forms must contain an actual signature. Web designation of representative/authorization form this form is to be used for a grievance or an appeal (see section d) and to allow a party to act as the authorized. This is the name of the person. Web to designate a representative, you must fill out and submit both of the forms below to the wtc health program. You can use our electronic.
You can use our electronic. You can use our electronic. This is the name of the person. Web designation of representative/authorization form this form is to be used for a grievance or an appeal (see section d) and to allow a party to act as the authorized. The forms must contain an actual signature. Web to designate a representative, you must fill out and submit both of the forms below to the wtc health program.
