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.