View our eStatement Agreement as it relates to the security of your banking information while using online banking services from Middlesex Savings Bank. Applicability. This Agreement includes the General Terms and Conditions which govern the use of all.Kindly fill out and sign the highlighted portions of the authorization letter. Include the full legal name of the authorized party and their relationship to the account holder. Account Holder Signature(s):. For the deceased's bank account, the account number and exact dollar amount in the account must be provided. Have any questions about your Novo account? My Authorized Representative in my application for Medicaid filed with the Eligibility Determining. Unemployment benefits. Bank Levy (taking funds from a bank account).