[s. 104]
[Heading inserted: No. 19 of 2010 s. 18(6).]
Form 1
ENDURING POWER OF ATTORNEY
This Enduring Power of Attorney is made on the ................... day of
............................. 20..........., by A.B. of
........................ under section 104 of the
Guardianship and Administration Act 1990 . | |
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1. I APPOINT C.D. of
.............................................................. (or C.D. of
......................... and E.F. of ............................ jointly)
(or C.D. of ........................ and E.F. of ............................
jointly and severally) to be my attorney(s). |
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1a. I APPOINT G.H. of
................................................................ 2. I AUTHORISE my attorney(s) to do on my behalf anything that I can lawfully
do by an attorney. |
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3. The authority of my attorney(s) is subject to the following conditions or
restrictions — |
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.......................................................................................................
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4. I DECLARE that this power of attorney * — | |
* One of |
(a) will continue in force notwithstanding my
subsequent legal incapacity; or (b) will be in force only during any period when a
declaration by the State Administrative Tribunal that I do not have legal
capacity is in force under section 106 of the Guardianship and Administration
Act 1990 . |
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SIGNED AS A DEED by:
............................................................. |
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WITNESSED by: |
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...........................................
...........................................
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...........................................
........................................... |
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...........................................
...........................................
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[Form 1 amended: No. 70 of 2000 s. 20(1); No. 55 of 2004 s. 465.]
Form 2
ACCEPTANCE OF ENDURING POWER OF ATTORNEY
I/We .............................., the person(s) appointed to be attorney
under paragraph 1 or 1a of the instrument on which this acceptance is endorsed
[or to which this acceptance is annexed] accept the appointment, and
acknowledge — | ||
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(a) that
the power of attorney is an enduring power of attorney and * — | |
* One of these |
(i)
will continue in force notwithstanding the subsequent
legal incapacity of the donor; (ii)
will be in force only during any period when a
declaration by the State Administrative Tribunal that the donor does not have
legal capacity is in force under section 106 of the
Guardianship and Administration Act 1990 ; and | |
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(b) that
I/we will, by accepting this power of attorney, be subject to the provisions
of Part 9 of the Guardianship and Administration Act 1990 . | |
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Signed: ......................................................................
or ......................................................................
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[Form 2 amended: No. 70 of 2000 s. 20(2); No. 55 of 2004 s. 465.]
[Schedule 4 omitted under the Reprints Act 1984 s. 7(4)(e).]