Date —————————————————————————————————————- To —————————————————————————————————————- —————————————————————————————————————-

I hereby authorize and request you to send copies of the following documents which I believe to be in your possession and which contain confidential information concerning me to:
Documents: —————————————————————————————————————- —————————————————————————————————————- —————————————————————————————————————-
I shall of course reimburse you for any reasonable costs incurred by you in providing the requested information.

Yours sincerely

Name ————————————————– Address ————————————————— ————————————————— —————————————————

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