Complete the Edir Third Party Informational Form 1

Input the information below to assist enrolling someone in GAECO Edir. Once you have completed this form, you will be directed to PayPal to make your first contribution. Thank you! This form is only for third parties submitting an informational form on behalf of the Testator.

If you would like to enroll as a single adult please click here or as married or with family here.

* indicates required

Person Filling Out Form on behalf of Testator *

Your Phone Number *

() –
(###) ###-####

Email Address *

Testator First Name *

Last Name *

Spouse First & Last Name (if applicable)

Family Status *

Phone Number *

() –
(###) ###-####

Address

Address Line 2

City

State/Province/Region

Postal / Zip Code

Country

Any children under 18? *

Any children between 18-23 attending college? *

Child 1 (First & Last Name)

Birthdate of Child 1

/ /
( mm / dd / yyyy )

Child 2 (First & Last Name)

Birthdate of Child 2

/ /
( mm / dd / yyyy )

Child 3 (First & Last Name)

Birthdate of Child 3

/ /
( mm / dd / yyyy )

Child 4 (First & Last Name)

Birthdate of Child 4

/ /
( mm / dd / yyyy )

Child 5 (First & Last Name)

Birthdate of Child 5

/ /
( mm / dd / yyyy )

Please take a moment to think about who you would like to act on your behalf in the event of your passing. This person will receive your Edir funds to make all arrangements for your funeral. Please enter this person’s information below:

Independent Executor First & Last Name *

Independent Executor Address

Address Line 2

City

State/Province/Region

Postal / Zip Code

Country

Independent Executor Email Address

Independent Executor Phone *

() –
(###) ###-####

I, the below named member, appoint my independent executor without bond upon my death. All above information is true to my knowledge.

Initials of Testator *

Complete the Edir Third Party Informational Form 1

Input the information below to assist enrolling someone in GAECO Edir. Once you have completed this form, you will be directed to PayPal to make your first contribution. Thank you! This form is only for third parties submitting an informational form on behalf of the Testator.

If you would like to enroll as a single adult please click here or as married or with family here.

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