Common use of Participant Signature Clause in Contracts

Participant Signature. Date Date Witness Printed Name Witness Signature Date Please return this form to Palco Printed Employer Name ID# / Last Four of SSN Employer Signature Date WV-2848 D

Participant Signature. Date Date Witness Printed Name Witness Signature Date Please return this form to Palco Printed Employer Name ID# / Last Four of SSN Date Employer Signature Date WV-2848 DSignature

Participant Signature. Date Date Witness Printed Name Witness Signature Date Please return this form to Palco Printed Employer Name ID# / Last Four of SSN Employer Signature Date WV-2848 DAuthorized Representative Declaration (Power of Attorney) NOTE: All information designated as “required” must be supplied for this authorization to be effective. Use Part 2 to revoke previous