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Get State Farm Total Loss Power Of Attorney Form

State Farm Mutual Funds Power of Attorney POA /Trading Authority This form is used to notify SFVPMC of a POA situation in which you will hold discretionary authority over a securities account on behalf of the account owner. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts. Please refer to Chapter 8 of the SFVPMC Compliance Manual for full details To aid us in identifying SFVPMC Registered Representatives RR holding POA please choose one of the following I am not affiliated with State Farm as an Agent Agent s Staff or Employee of State Farm I am a non-RR State Farm Agent non-RR Agent s Staff member or non-RR Employee of State Farm Alias I am a RR State Farm Agent RR Agent s Staff member or RR Employee of 3 Additional Information I am Power of Attorney for Name Account Number s If you are a Registered Representative of SFVPMC please complete the following My relationship to this individual is e.g. father sister friend 4 POA Signature Date Mail or fax form and copy of POA document to P. If you have any questions or need additional information before completing this form please call 1-800-447-4930. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts. If you have any questions or need additional information before completing this form please call 1-800-447-4930. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts. If you have any questions or need additional information before completing this form please call 1-800-447-4930. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts.

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