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Policy Review Authorization

Date
MM slash DD slash YYYY
Name of Insurance Company
First
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Policy #
Name of Insured
First Last
Name of Policy Owner
First Last
Date of Birth
MM slash DD slash YYYY
SS#
Please accept this letter as authorization for the below named individual/firm to be provided with any and all information regarding the above referenced policies, including current in-force ledgers.
Agent: Katie Weibel & Julianne Lepo / Specific Solutions, 475 International Drive, Williamsville, NY 14221 - Fax: 716-632-6051
*
- I authorize Katie Weibel & Julianne Lepo / Specific Solutions to obtain any and all information, including in-force ledgers.

New York State Dispute Resolution Association, Inc

National Association for the Self-Employed

Association of Divorce Financial Planners (ADFP)

Financial Planning Association

American Business Women’s Association

Niagara River Region’s Chamber of Commerce

The above entities are not affiliated with Turning Tides Financial and LPL Financial.

Office of Supervisory Jurisdiction through

© Turning Tides Financial LLC

Securities offered through LPL Financial, Member FINRA/SIPC.
Investment advice offered through Silver Grove Advisory Services, a registered investment advisor. Silver Grove Advisory Services, and Turning Tides Financial are separate entities from LPL Financial.

The LPL Financial registered representatives associated with this page may only discuss and/or transact business with residents of the following states: CA, FL, MD, NJ, NY and OH.

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