Regulation 5 of the Powers of Attorney Regulations 2015 This enduring power of attorney is made under Part 3 of the Powers of Attorneys Act 2014 and has effect as a deed under section 81 of the Act.
1. Appointment of attorney/s by the Principal
The Principal
You, the person who appoints the attorney
Appoint
The Attorney/s
The person/position you nominate to look after your legal and financial affairs
Nomination of Alternative Attorney/s (optional)
If your attorney/s vacates office, you have the option to nominate someone to take their place
Note: Under section 31(3) of the Act, an alternative attorney must act in the same manner as the attorney for whom the alternative attorney is appointed to act unless you provide otherwise.
2. Authorisation
Select what type of Authorisation you are giving
I authorise my Attorney/s:
3. Revocation
Select to specify about your previous Enduring Power of Attorney
Note: Under section 55 of the Act, an enduring power of attorney is revoked by a later enduring power of attorney of the principal, unless the principal specifies otherwise.
4. Commencement
Choose one option only. If no option is chosen the power is exercisable immediately.
The powers under this enduring power of attorney for all matters are exercisable:
specify time, circumstance or occasion when the power is exercisable
5. Conditions and Instructions
You can place conditions on or give instructions to your attorney. If you do not want to place any conditions or give instructions, write the word 'NIL'.
The exercise of power under this enduring power of attorney is subject to the following conditions or instructions:
6. Your signature to make the appointment
You must sign and have it witnessed by two (2) witnesses
Signature of principal:
Date:
Name and address of person signing at direction of principal
I sign this enduring power of attorney at the direction of and in the presence of the principal.
7. Certificate of Witnesses
Witnessed by:
First Witness
Name and address of witness
Each witness certifies that:
• the principal appeared to freely and voluntarily sign this instrument in our presence; and
• in my presence, the principal appeared to freely and voluntarily direct the person to sign for the principal and that person signed this instrument in my presence and in the presence of the principal; and
• at that time, the principal appeared to me to have decision making capacity in relation to the making of this enduring power of attorney; and
• I am not an attorney under this enduring power of attorney; and
• I am not a relative of the principal or of an attorney under this enduring power of attorney; and
• I am not a care worker or accommodation provider for the principal.
• I am not the person who is signing at the direction of the principal.
If first witness is acting as a medical practitioner or person authorised to witness affidavits insert qualification
Signature of First Witness:
Date:
Second Witness
Name and address of witness
Each witness certifies that:
• the principal appeared to freely and voluntarily sign this instrument in our presence; and
• in my presence, the principal appeared to freely and voluntarily direct the person to sign for the principal and that person signed this instrument in my presence and in the presence of the principal; and
• at that time, the principal appeared to me to have decision making capacity in relation to the making of this enduring power of attorney; and
• I am not an attorney under this enduring power of attorney; and
• I am not a relative of the principal or of an attorney under this enduring power of attorney; and
• I am not a care worker or accommodation provider for the principal.
• I am not the person who is signing at the direction of the principal.
If second witness is acting as a medical practitioner or person authorised to witness affidavits insert qualification
Signature of Second Witness:
Date:
8. Statement of Acceptance of Appointment – Attorney
Note: Each attorney must sign a statement of acceptance and it must be witnessed separately in the enduring power of attorney.