Power of Attorney Application
1. Your details

Name:


Address:


Email address:


Phone number:


2. Name of person/s you wish to appoint as your attorney/s:


3. Do you wish to appoint more than one attorney?

 No (go to 5)
 Yes

4. How would you prefer they make their decisions?

 Severally (any one of them may decide)

 Jointly (unanimously)

 As a majority (specify, eg simple majority, two-thirds majority etc)

 Other (NOTE: The Powers of Attorney Act 1998 allows you to appoint successive attorney/s for a matter so that the power is given to a particular attorney only when power to a previous attorney ends. You can nominate the circumstances that a power will end (eg if x leaves the jurisdiction, y may act)


5. The attorney/s power should be subject to the following terms:


6. The power given to your attorney/s should begin:

 Immediately

 On this date:


 On this occasion:

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