Instructions for Authorized Representatives

Power of Attorney/Doctor’s Form

 Important: only complete this form if you are an authorized representative. If the applicant can sign the form himself/herself, the doctor’s form is not required.

If claimant is unable to sign Claims Conference documentation, such as an application form or a life certificate, an authorized representative may sign on his/her behalf. The authorized representatives must submit ALL of the following documents to the Claims Conference:

  • Photocopy of a Power of Attorney or a document granting legal guardianship;
  • Photocopy of the authorized representative’s government issued ID;
  • Doctor’s Form completed by the claimant’s physician.

Please note: the doctor must have seen the claimant within the past two months in order for this form to be accepted by the Claims Conference.

Download the Form in Your Preferred Language

Doctor’s Form | Arztformular | טופס רופא  | Формуляр врача | Formulaire “Médecin”