Update Existing Duly Authorized Personnel Information

Update Existing Duly Authorized Personnel Information

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Private Provider Legal Business Name
To find your existing AEC Number, follow these steps:
- Log in to eTRAKIT and select VIEW/EDIT PROFILE.
- The number displayed above your email address is your AEC number.
Your AEC Number
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email
example@example.com
This section is to ADD a Duly Authorized Personnel

The update and remove Duly Authorized Personnel sections are below.
Add a Duly Authorized Personnel List. Add as many rows as you need.
The private provider or private provider firm must update its registration within 5 business days after any change to the provider’s or firm’s contact information, licensure, or insurance coverage.
Complete the Private Provider Acknowledgment and upload it.
Private Provider Acknowledgement

Upload Document
Cancelof
This section is to UPDATE a Duly Authorized Personnel

The remove Duly Authorized Personnel section is below.
Complete the Private Provider Acknowledgment and upload it.
Private Provider Acknowledgement

Upload Document
Cancelof
This section is to REMOVE Duly Authorized Personnel

The remove Duly Authorized Personnel section is below.
Remove a Duly Authorized Personnel List. Add as many rows as you need.
By typing my name in the below space, I am electronically signing this form. By signing this electronic signature certifies the information to be true, accurate, and complete.

First NameLast Name
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Update Existing Duly Authorized Personnel Information

This section is to ADD a Duly Authorized Personnel

This section is to UPDATE a Duly Authorized Personnel

This section is to REMOVE Duly Authorized Personnel