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Scope of appointment

Attached is a Scope of Appointment form.  This form does not change or enroll you in anything.  It just says you agree to have a sales agent go over your options.  Please initial the 5 top boxes, sign as the beneficiary.  This form needs to be dated at least 2 days prior to our appointment.  Then I get to keep it for 10 years in case Medicare wants to see it.