Western Australian Repealed Regulations

This legislation has been repealed.

RULES OF THE GUARDIANSHIP AND ADMINISTRATION BOARD - SCHEDULE

FORM A

ESTATE INFORMATION FORM

When completed please return to the Executive Office of the Guardianship and Administration Board, Perth.

If exact replies cannot be given, give approximate details. If the space provided for any answer is insufficient please attach a separate sheet.

1.         DETAILS OF THE REPRESENTED PERSON

Miss ............................................................................................................................. Mrs ............................................................................................................................. Dr/Mr         (Given Names)         (Surname) Current Address .............................................................................................................. .................................................................................................. Postcode ...................... Residential Address ........................................................................................................... ................................................................................................. Postcode ...................... Phone: (Home) ........................... (Work) ....................................... Date of Birth ...../..../......

2.         RELATIVES
FULL NAME	ADDRESS (If deceased give date and place of death)
Spouse or de facto partner
Sons and Daughter (if under 21 years also give date of birth
Parent/s
Brothers and Sisters

3.         SALARY OR WAGES DUE TO THE REPRESENTED PERSON
Name of Employer	Address of Employer	Amount due or entitlement

4.         BENEFIT (War, Invalid, Age, Service, Superannuation, Overseas, Annuity, Retiring Allowance
Type of Benefit	Benefit Number	Source from which received

5.         DETAILS OF SERVICE IN ARMED FORCES
Regimental Number	Unit	Rank
If possible, state date of enlistment and discharge, and areas of service

6.         TAXATION
Is the Represented Person liable to lodge Income Tax Returns? YES/NO*	If liable was a return lodged for year ended 30 June last? YES/NO*
File No.	Please attach copy of last return if applicable or give Name and Address of Accountant or Tax Agent who may have completed last return.

7.         REAL ESTATE (Including any Interest therein)
Description (e.g. Land, House and Land, Shop Property, etc.) and Full Address
Who holds title documents?	Name in which title stands or interest in property
Is property subject to mortgage? (please give details).
If buildings are insured, state Name of Insurer and give details of Policy.
Who occupies property?
If property is vacant, give Name and Address of person holding keys.
If property is let, state amount of rental, date to which paid and by whom collected.

*Strike our whichever is not applicable.

8.         FURNITURE DESCRIPTION

Local of furniture

If furniture is insured, state Name of Insurer and give details of Policy

9.         PERSONAL EFFECTS (Clothing, books, tools, jewelry, etc)

Description and location of effects.

10.         BANK OR BUILDING SOCIETY ACCOUNTS
Name	Branch	Account Number	Location of Passbook or Card	Balance

11.         SHARES, STOCK UNITS, DEBENTURES, ETC
Name	Branch	Account Number	Location of Passbook or Card

12.         MONEY INVESTED IN PUBLIC LOANS
Borrowing Authority	Amount Invested	Interest Rate and date of Maturity	No. and Location of Receipt or Certificate

13.         MONEY LOANED ON MORTGATE

Give full details, including nature of security and Name and Address of person who holds documents.

14.         LIFE ASSURANCE
Name of Company	Policy Number	Premium	Premium Payable By	Policy Held By

15.         INTEREST IN AN ESTATE
Name of Deceased	Date and Place of Death	Name and Address of Administrator and/or Solicitor

16.         VEHICLES OR AGRICULTURE EQUIPMENT
Make	Model and Year	Type	Registration Number
Location of Vehicle
In Whose Care
Particulars of Comprehensive Insurance

17.         LIVESTOCK (Horses, Cattle, Sheep, etc.)

Description, Location and Number of Livestock

Name and Address of person who has charge of stock

18.         GOODS ON HIRE PURCHASE OR LEASE
Description of Goods	Name and Address of Finance Company and/or Dealer or Lessor

19.         DEBTS DUE TO REPRESENTED PERSON
Name of Debtor	Address of Debtor	Amount Owing

20.         DETAILS OF ANY OTHER ASSETS, INTEREST OR ENTITLEMENTS

Please give description

21.         FEES OF NURSING HOME, PRIVATE HOSPITAL etc
Name and Address of Home, Hospital, etc.
Weekly Fee Charged.	Date to Which Fees Paid.

22.         HOSPITAL AND MEDICAL FUND, BENEFIT OR FRIENDLY SOCIETY
Name of Fund or Society	Membership Number and Nature of Cover
Location of Subscription Book (if applicable)

23.         DEBTS OWING BY REPRESENTED PERSON (Please list all debts currently outstanding)
Name of Creditor	Address of Creditor	Amount Owing

24.         WILL
Has the Represented Person made a Will? YES/NO*	If so, who holds Will? (Attach a copy if possible)

25.         POWER OF ATTORNEY

Has the Represented Person executed a Power of Attorney? YES/NO*

Date when Power of Attorney granted.

Name and Address of person in favour of whom Power of Attorney was given.

* Strike out whichever is not applicable

26.         SOLICITOR

Name and address of Solicitor who may have acted for protected person.

27.         ACCIDENTS

Please set out below full particulars of any accident, within the last six years, in which the Represented Person was injured. What action (if any) has already taken place to pursue either a claim for damages at Common Law or a claim for compensation pursuant to the provisions of the Workers’ Compensation Act?

28.         OTHER MATTERS

Please mention any matters or offer any suggestions which you consider might be of assistance in the management of the Represented Person’s affairs.

29.         OUTLINE OF PROPOSALS

Outline the way in which, over the next 12 months, you propose to deal with the Represented Person’s assets including what you expect the annual income and expenses will be.

30.         DECLARATION BY ADMINISTRATOR

I have read this completed form and consider to the best of my knowledge, that all of the information provided is true and correct, is not misleading and that no relevant information has been omitted. Signature of Administrator ........................................................ Date ..................../......../....../

[Form A amended in Gazette 30 Jun 2003 p. 2630.]

FORM B

STATEMENT OF ACCOUNT No. ........................

In the Estate of        

From ................................ 19........ to         19........

Receipts	Amount		Payments	Amount
To balance form account No. General Receipts as per Abstract 1			To balance from account No. Payment as per Abstract 2
BALANCE ............			BALANCE ..........
$			$

(Signature of Deponent)        

This is the account numbered “........................” with abstracts referred to in the accompanying affidavit of (name of Administrator)        

Sworn before me this .................. day of ............................ 19..............

.......................................

(Signature of Commissioner for

Affidavits/Justice of Peace)

I certify that this account has been checked and audited and found to be correct and that the same is passed.

        Date: ......................

        Board/Public Trustee

ABSTRACT 1 — RECEIPTS

In the estate of        

From ............................... 19......... to ................................ 19.........

No of Item	Date when received	Names of person from whom received	Particulars	Amount received
RENTS RECEIVED AS PER ABSTRACT 3 $
CARRY TOTAL TO STATEMENT OF ACCOUNT No. .... $

(Signature):        

ABSTRACT 2 — DISBURSEMENTS

In the estate of        

From ............................... 19......... to ................................ 19.........

No of Item	Date when paid or allowed	Names of person to whom paid or allowed	For what purposes paid or allowed	Amount paid
EXPENDITURE ON PROPERTY AS PER ABSTRACT 4 $
CARRY TOTAL TO STATEMENT OF ACCOUNT No. ...... $

(Signature):        

ABSTRACT 3 — STATEMENT OF RENTS

COLLECTED BY ADMINISTRATOR

In the estate of        

From ............................... 19......... to ................................ 19.........

Address of Property

Tenant’s Name

Rent Payable and Whether Weekly, Monthly etc. $   c

Arrears at Opening Day of Account $   c

Total Rent Due (Including Arrears) $   c

Rent Received $   c

Arrears at Closing Date of Account $   c

Remarks e.g. Change of Tenant, Rent Insurance, etc. (with dates)

CARRY TOTAL TO ABSTRACT 1 — “RECEIPTS” $

(Signature):        

ABSTRACT 4 — STATEMENT OF EXPENDITURE ON RENTED PROPERTY PAID BY ADMINISTRATOR

In the Estate of        

From ............................... 19......... to ................................ 19.........

Date	No.	Address Property Concerned	Nature of Expenditure and to Whom Paid	$  c
				$
CARRY TOTAL TO ABSTRACT 2 — “DISBURSEMENTS” $

(Signature): .................................................................................

ABSTRACT 5 — ASSETS

In the Estate of ..............................................................................

Particulars of Assets as at .................................................................

Particulars	Title Deeds and other securities by whom held	Amount or Value

(Signature): .................................................................................

ABSTRACT 6 — LIABILITIES

In the Estate of ..............................................................................

Particulars of Liabilities as at ............................................................

Particulars	Amount

(Signature): .................................................................................

FORM C

AFFIDAVIT VERIFYING ACCOUNT

On .........................., 19........, I        
        (Name, address and occupation)

say on oath — 

1. I am the Administrator of the estate of        

        (“the Represented Person”).
        (Name of Represented Person)

2.         The account number “................” with abstracts, all of which have been lodged by me, contain a full and true account of all moneys belonging to the said Represented Person received by me or by any other person on my behalf from the        

............................. 19........, to the         19........

3.         The several sums of money mentioned in the said account and abstracts as having been paid have been actually paid by or allowed by me for or on account of the estate of the Represented Person for the several purposes specified. The said account and abstracts disclose the whole of the moneys paid or allowed by me or by any other person on my behalf in the said estate for the aforesaid period together with details of all assets belonging to the Represented Person and details of liabilities owed by the Represented Person.

..........................         ....................................................
Deponent         Commissioner for Affidavits/Justice of
the Peace

4.         There is not, to the best of my knowledge and belief, any error or omission in the said account and abstracts.

SWORN at ............... in the said         }
State of Western Australia this ......         }
day of ........................ 19.......         }

BEFORE ME:        

A Commissioner of the Supreme Court of Western Australia for
taking Affidavits
or
Justice of the Peace

        [Schedule amended in Gazette 30 June 2003 p.2630.]