Trusted Contact Authorization Form Completed Form Examples and Samples
Explore a detailed example of a filled-out Trusted Contact Authorization Form. Our free sample provides a clear template to help you correctly designate a trusted person for your financial accounts, ensuring your assets are protected. Understand the key fields and how to complete the form accurately.
Trusted Contact Authorization Form Example
How this form was filled:
This is a sample Trusted Contact Authorization Form filled out by an account holder, Jane Doe, to designate her son, John Doe, as her trusted contact. The form correctly provides all required information for both the account holder and the designated contact, and is properly signed and dated for the year 2026.
Information used to fill out the document:
- Account Holder's Name: Jane M. Doe
- Account Number: 123-45678-90
- Account Holder's Address: 456 Oak Avenue, Anytown, USA 12345
- Account Holder's Phone: (555) 123-4567
- Account Holder's Email: [email protected]
- Trusted Contact's Name: John A. Doe
- Trusted Contact's Relationship: Son
- Trusted Contact's Address: 789 Pine Street, Somecity, USA 67890
- Trusted Contact's Phone: (555) 987-6543
- Trusted Contact's Email: [email protected]
- Signature: Jane M. Doe
- Date: 05/20/2026
What this filled form sample shows:
- Clearly identifies the account holder and their primary account number.
- Provides complete and distinct contact information for both the account holder and the trusted contact.
- Specifies the relationship of the trusted contact to the account holder.
- Includes a proper signature and date to officially authorize the designation.
Form specifications and details:
| Use Case: | Individual account holder appointing a family member as a trusted contact for a personal investment account. |
| Purpose: | To authorize a financial institution to contact a designated individual in circumstances such as suspected financial exploitation or concerns about the account holder's health, in accordance with industry regulations. |
Created: February 25, 2026 06:47 PM
