Pro-Forma Authorization For Practitioner To Submit 5500 Form

[Andy the Actuary]

Burp, Inc. authorizes Andy the Actuary to submit our 5500.

Whata Burp, President

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Andy the Actuary acknowledges receipt of Burp, Inc.'s authorization to have me submit their 5500.

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Burp, Inc. acknowledges that Andy the Actuary notified me of receipt of my authorization for him to submit our 5500.

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Andy the Actuary confirms that I have received Burp, Inc. acknowledgment that they received my acknowledgment of

their authorization for me to submit their 5500.

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And keep a goin' . . .