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VICTORIA Form 1 Enduring Power of Attorney Appointment of 12State Trustees Power of Attorney Kit (Version 1508)

FORM 1ENDURING POWER OF ATTORNEY

This enduring power of attorney is made under Part 3 of the Powers of Attorney Act 2014 (the ‘Act’) and has effect as a deed under section 81 of the Act.

Name of principal [Insert your full name]

Address of principal [Insert your residential address]

1. APPOINTMENT

I appoint [Insert full name of attorney]

of [Insert residential address of attorney]

If you are appointing more than one attorney, insert the full name and address of each additional attorney in the

appropriate space below. Cross out any part you do not use.

AND [Insert the full name of your second attorney if applicable]

of [Insert residential address of your second attorney if applicable]

AND [Insert the full name of your third attorney if applicable]

of [Insert residential address of your third attorney if applicable]

If you are appointing only one attorney, tick the following option.

to be my attorney.

If you are appointing more than one attorney, tick one of the following options. If no option is selected, your attorneys will be taken to be appointed as joint attorneys.

to be my joint attorneys

to be my several attorneys

to be my joint and several attorneys

to be my majority attorneys

ENDURING POWER OF ATTORNEYSTATE OF VICTORIA

STAPLE ALL SHEETS FOR FORM 1 TOGETHER HERE

I hereby:

(a) specify that all previous enduring powers of attorney made by me under the Act are revoked; and

(b) revoke all old enduring powers of attorney (within the meaning of section 140 of the Act) made by me; with the following exceptions, which I specify and declare are not to any extent hereby revoked:

You must tick one option, and one only.

No exceptions

[All previous Victorian enduring powers of attorney made by you will be revoked]

The enduring power(s) of attorney made by me on:

[Insert the dates (on which you made) of any enduring power(s) of attorney you are not revoking]

Note: Under section 55 of the Powers of Attorney Act 2014 any other enduring power of attorney will be revoked to the extent of any inconsistency with this enduring power of attorney, unless you specify otherwise.

If you are appointing one or more alternative attorney(s), insert the full name and address of each alternative attorney in the appropriate space below and cross out any part you do not use, otherwise cross out the entire section.

and I appoint [Insert the name of alternative attorney]

of [Insert the residential address of alternative attorney]

as alternative attorney for [Insert the full name of the attorney for whom the alternative attorney is appointed]

AND [Insert the full name of your second alternative attorney if applicable]

of [Insert the residential address of your second alternative attorney if applicable]

as alternative attorney for [Insert the full name of the attorney for whom the second alternative attorney is appointed]

AND[Insert the full name of your third alternative attorney if applicable]

of

[Insert the residential address of your third alternative attorney if applicable] as alternative attorney for [Insert the full name of the attorney for whom the third alternative attorney is appointed]


ENDURING POWER OF ATTORNEYSTATE OF VICTORIA

ENDURING POWER OF ATTORNEY

Note: Under section 31 of the Powers of Attorney Act 2014 an alternative attorney is authorised to act in the circumstances you specify in this enduring power of attorney or, if you do not specify any circumstances, in the circumstances specified in section 31(2)(b) of the Act.

Section 31(2)(b) of the Act specifies that your alternative attorney(s) will be authorised to act in the following circumstances: if the attorney for whom the alternative attorney is appointed (i) dies; or (ii) does not have decision making capacity for the matter(s) to which the appointment applies; or (iii) is otherwise not willing or able to act; or (iv) the power given to them is revoked because they have become insolvent under administration, or have become a care worker, health provider or accommodation provider for you or, in the case of an attorney for financial matters, the attorney is convicted or found guilty of an offence involving dishonesty.

If you have appointed one or more alternative attorneys and wish to specify the circumstances in which you are authorising the alternative attorney(s) to act, complete the following section. If you have not appointed an alternative attorney, cross out this section.

I authorise my alternative attorney(s) to act in the circumstances described below.

2. AUTHORISATION

Tick option 2.1 or 2.2 below (whichever is applicable). Choose one and only one option.

2.1 Authorisation for all personal matters, all financial matters, or all personal and financial matters

If you are authorising your attorney(s) to exercise power for personal matters, or financial matters, or both personal and financial matters, tick the appropriate option below.

I authorise my attorney(s) to do anything on my behalf that I can lawfully do by an attorney for

personal matters

financial matters

both personal and financial matters

If you are not authorising your attorney(s) to exercise power for all personal and/or financial matters, specify below the matter(s) and the attorney(s) to whom the matter(s) apply. If different attorneys are appointed for different matters, specify how these attorneys are to act, e.g. jointly and for which matters.

STATE OF VICTORIA



OR

2.2 Authorisation to do anything that can be done by an attorney

If you are authorising your attorney(s) to do anything you can lawfully do by an attorney choose this option.

I authorise my attorney(s) to do anything on my behalf that I can lawfully do by an attorney (see section 22(1) of the Act).

3. COMMENCEMENT

The powers under this enduring power of attorney for all matters are exercisable:

Tick one option only. If no option is chosen the power begins immediately.

immediately on the making of the power

when I cease to have decision making capacity for the matter(s)

from the following time, in the following circumstance or, on the following occasion

If the power for any specified matter(s) is exercisable from a different time, in a different circumstance or on a different occasion to other matter(s) in the enduring power, specify the matter(s) and when they are exercisable.

[Insert other time, circumstance or occasion]

STATE OF VICTORIA



4. CONDITIONS AND INSTRUCTIONS Complete the following section if you wish to place conditions on the exercise of the power, or give instructions about the exercise of the power, otherwise write NIL. DO NOT CROSS out any part of this section.

The exercise of power under this enduring power of attorney is subject to the following conditions and/or instructions:

[Insert conditions or instructions (if any)]

Signed

[Signature of principal or person signing at the direction of (on behalf of) the principal]

Date [Principal or person signing at the direction of (on behalf of) the principal to write the date here]

Tick the following option if the enduring power of attorney is being signed by a person at the direction of the principal.

I sign this enduring power of attorney at the direction of and in presence of the principal.

Name of person signing at direction of principal

Address of person signing at direction of principal

STATE OF VICTORIA



CERTIFICATE OF WITNESSES

Witnessed by

Name of first witness [Insert full name of first witness]

Address of first witness [Insert residential address of first witness]

Name of second witness [Insert full name of second witness]

Address of second witness [Insert residential address of second witness]

Each witness certifies under section 36 of the Powers of Attorney Act 2014 that:

Tick either Option A or Option B below.

If witnessing for the principal signing, tick this option.

Option A • the principal appeared to freely and voluntarily sign this instrument in our presence; • at that time, the principal appeared to us to have decision making capacity in relation

to the making of this enduring power of attorney; • we are not attorneys under this enduring power of attorney; • we are not relatives of the principal or of an attorney under this enduring power of attorney; and • we are not care workers or accommodation providers for the principal.

If witnessing another person signing at the direction and in the presence of the principal, tick this option.

Option B • we are not the person who is signing at the direction of the principal; • in our presence, the principal appeared to freely and voluntarily direct the person to sign

for the principal and that person signed this instrument in our presence and in the presence of the principal;

• at that time, the principal appeared to us to have decision making capacity in relation to the making of this enduring power of attorney;

• we are not attorneys under this enduring power of attorney; • we are not relatives of the principal or of an attorney under this enduring power of attorney; and • we are not care workers or accommodation providers for the principal.Signed

First witness [Signature of first witness]

Qualification of first witness [Insert qualification of first witness if acting as a medical practitioner or person authorised to witness affidavits]

Second witness [Signature of second witness]

Qualification of second witness [Insert qualification of second witness if acting as a medical practitioner or person authorised to witness affidavits]

Date [Insert date]

STATE OF VICTORIA



STATEMENT OF ACCEPTANCE OF APPOINTMENT - ATTORNEY

Each attorney must sign a statement of acceptance and it must be witnessed separately, as set out below.

The attorney or, if there is more than one attorney, the first attorney, completes this section.

Name of attorney [Insert full name of attorney]

Address of attorney [Insert residential address of attorney]

I accept my appointment as attorney under this enduring power of attorney and state that:

- I am eligible under Part 3 of the Powers of Attorney Act 2014 to act as an attorney under an enduring power of attorney; and

- I understand the obligations of an attorney under an enduring power of attorney and under the Powers of Attorney Act 2014 and the consequences of failing to comply with those obligations; and

- I undertake to act in accordance with the provisions of the Powers of Attorney Act 2014 that relate to enduring powers of attorney.

If appointed for financial matters and you have been convicted or found guilty of an offence involving dishonesty, tick the box below.

I have disclosed to the principal that I have been convicted or found guilty of an offence involving dishonesty.

Signed

Date [Attorney to sign] [Insert date]

Witnessed by

Name of witness [Insert full name of witness]

Address of witness [Insert residential address of witness]

I witnessed the signing of the statement of acceptance by the attorney.

Signed

Date [Witness to sign] [Insert date]

Note: Each attorney must sign a statement of acceptance and it must be witnessed separately in the enduring power of attorney.

STATE OF VICTORIA



The second attorney, if any, completes this section.

Name of attorney [Insert full name of second attorney]

Address of attorney [Insert residential address of second attorney]







Signed

Date [Second attorney to sign] [Insert date]

Witnessed by




Signed



STATE OF VICTORIA



The third attorney, if any, completes this section.

Name of attorney [Insert full name of third attorney]

Address of attorney [Insert residential address of third attorney]







Signed

Date [Third attorney to sign] [Insert date]

Witnessed by




Signed



STATE OF VICTORIA



STATEMENT OF ACCEPTANCE OF APPOINTMENT - ALTERNATIVE ATTORNEY

If appointing alternative attorney(s), each alternative attorney must sign a statement of acceptance and it must be witnessed separately, as set out below.

The alternative attorney or, if there is more than one alternative attorney, the first alternative attorney, completes this section.

Name of alternative attorney [Insert full name of alternative attorney]

Address of alternative attorney [Insert residential address of alternative attorney]

I accept my appointment as alternative attorney under this enduring power of attorney and state that:



- I undertake to act in accordance with the provisions of the Powers of Attorney Act 2014 that relate to enduring powers of attorney;

- I understand the circumstances in which the alternative attorney is authorised to act under the Powers of Attorney Act 2014; and - I am prepared to act in place of the attorney for whom I am appointed, if still eligible to act as attorney, when authorised to do so under the Powers of Attorney Act 2014.



Signed

Date [Alternative attorney to sign] [Insert date]

Witnessed by



I witnessed the signing of the statement of acceptance by the alternative attorney.

Signed


Note: Each alternative attorney must sign a statement of acceptance and it must be witnessed separately in the enduring power of attorney.

STATE OF VICTORIA



The second alternative attorney, if any, completes this section.

Name of alternative attorney [Insert full name of second alternative attorney]

Address of alternative attorney [Insert residential address of second alternative attorney]








Signed

Date [Second alternative attorney to sign] [Insert date]

Witnessed by




Signed



STATE OF VICTORIA

VICTORIA Form 1 Enduring Power of Attorney Appointment of 12 State Trustees Power of Attorney Kit (Version 1508)


The third alternative attorney, if any, completes this section.

Name of alternative attorney [Insert full name of third alternative attorney]

Address of alternative attorney [Insert residential address of third alternative attorney]








Signed

Date [Third alternative attorney to sign] [Insert date]

Witnessed by




Signed



STATE OF VICTORIA

VICTORIA Form 1 Enduring Power of Attorney Appointment of 12 State Trustees Power of Attorney Kit (Version 1508)

ENDURING POWER OF ATTORNEY (MEDICAL TREATMENT)

This enduring power of attorney (medical treatment) is given on the [Insert date on which this document is to be signed and witnessed]

by (donor) [Insert your full name]

of [Insert your residential address]

under section 5A of the Medical Treatment Act 1988.

Use this section if you wish to appoint one agent and no alternative agent, otherwise cross out this section.

1(a). I appoint [Insert full name of agent]

of to be my agent.[Insert residential address of agent]

OR

Use this section if you wish to appoint one agent and one alternative agent, otherwise cross out this section.

1(b). I appoint [Insert full name of agent]

of to be my agent [Insert residential address of agent]

and [Insert full name of alternative agent]

of [Insert residential address of alternative agent]

to be my alternate agent.

2. I AUTHORISE my agent or, if applicable, my alternate agent, to make decisions about medical treatment on my behalf.

3. I REVOKE all other enduring powers of attorney (medical treatment) previously given by me.

SIGNED, SEALED AND DELIVERED by:

[Signature of donor]

STATE OF VICTORIA

VICTORIA Enduring Power of Attorney (Medical Treatment) PAGE 1 OF 2State Trustees Power of Attorney Kit (Version 1508)

STAPLE BOTH SHEETS (PAGES 1 TO 2) TOGETHER HERE

ENDURING POWER OF ATTORNEY (MEDICAL TREATMENT)

CERTIFICATE OF WITNESS

We and [Name of first witness authorised to sign statutory declarations] [Name of second witness]

each believe that the donor in making this enduring power of attorney (medical treatment) is of sound mind and understands the import of this document.

WITNESSED by:

[Signature of witness authorised to sign [Signature of second witness] statutory declarations authorised witness]

[Name and qualification of authorised witness] [Name of second witness]

[Address of authorised witness] [Address of second witness]

NOTE: Section 5A(2)(a) requires at least one of the witnesses to this instrument to be a person authorised by law to take and receive statutory declarations.

STATE OF VICTORIA

VICTORIA Enduring Power of Attorney (Medical Treatment) PAGE 2 OF 2State Trustees Power of Attorney Kit (Version 1505)

GENERAL NON-ENDURING POWER OF ATTORNEYSTATE OF VICTORIA

This general non-enduring power of attorney is made under Part 2 of the Powers of Attorney Act 2014 and has effect as a deed.

This general non-enduring power of attorney is made on [Insert date]

I

[Insert your full name]

of [Insert your residential address]

appoint [Insert full name of your first attorney]

of [Insert residential address of your first attorney]

If you are appointing more than one attorney, write the full name and residential address of each additional attorney in the appropriate space below. Cross out any part you do not use.

AND [Insert full name of your second attorney if applicable]

of [Insert residential address of your second attorney if applicable]

AND [Insert full name of your third attorney if applicable]

of [Insert residential address of your third attorney if applicable]

You must tick one option, and one only.

to be my attorney.

jointly to be my attorneys.

jointly and severally to be my attorneys.

VICTORIA General Non-Enduring Power of Attorney Page 1 of 3State Trustees Power of Attorney Kit (Version 1508)

STAPLE BOTH SHEETS (PAGES 1 TO 3) TOGETHER HERE


If you are appointing one or more alternative attorney(s), write the full name and address of each alternative attorney in the appropriate space below. Cross out any part you do not use.

And I appoint [Insert full name of alternative attorney]

of [Insert residential address of alternative attorney]

as alternative attorney for [Insert full name of the attorney for whom the alternative attorney is appointed]

AND [Insert full name of your second alternative attorney if applicable]

of [Insert residential address of your second alternative attorney if applicable]

as alternative attorney for [Insert full name of the attorney for whom your second alternative attorney is appointed]

AND [Insert full name of your third alternative attorney if applicable]

of [Insert residential address of your third alternative attorney if applicable]

as alternative attorney for [Insert full name of the attorney for whom the third alternative attorney is appointed]

I authorise my attorney(s) to do on my behalf anything that I may lawfully authorise an attorney to do, subject to the following conditions, limitations and/or instructions:

If you wish to provide any conditions or limitations on, or instructions about, the exercise of powers by your attorney(s), write them in the space below, otherwise write ‘NIL’. DO NOT CROSS OUT any part of this section.



I specify that this power of attorney begins:

Tick one option only. If no option is chosen, the power begins immediately.

immediately

on this date [Insert date]

on this occasion [Insert occasion]

Signed as a deed by

Signed [Signature of principal]



Signature of witness [Signature of witness]


APPOINTMENT OF SUPPORTIVE ATTORNEY

FORM 5APPOINTMENT OF SUPPORTIVE ATTORNEY

This supportive attorney appointment is made under Part 7 of the Powers of Attorney Act 2014.

Name of principal [Insert your full name]

Address of principal [Insert your residential address]

1. APPOINTMENT

I appoint [Insert full name of supportive attorney]

of [Insert residential address of supportive attorney]

If you are appointing a second supportive attorney, complete the following section, otherwise cross out the word ‘AND’ and the next two lines.

AND

[Insert full name of second supportive attorney if applicable]

of [Insert residential address of second supportive attorney if applicable]

to act as my supportive attorney(s).

If you wish to appoint one or two alternative supportive attorney(s), complete the following section, otherwise cross it out.

AND

I appoint [Insert full name of alternative supportive attorney]

of [Insert residential address of alternative supportive attorney]

as alternative supportive attorney for [Insert full name of supportive attorney for whom the alternative supportive attorney is appointed]

If you are appointing a second alternative supportive attorney, complete the following section, otherwise cross out the word ‘AND’ and the next two lines.

AND

[Insert full name of second alternative supportive attorney]

of [Insert residential address of second alternative supportive attorney]

as alternative supportive attorney for [Insert full name of supportive attorney for whom the second alternative supportive attorney is appointed]

STATE OF VICTORIA

VICTORIA Form 5 Appointment of Supportive Attorney PAgE 1 OF 9State Trustees Power of Attorney Kit (Version 1508)

STAPLE ALL SHEETS FOR FORM 5 TOgETHER HERE

APPOINTMENT OF SUPPORTIVE ATTORNEY

Note: Under section 93 of the Powers of Attorney Act 2014 an alternative supportive attorney is authorised to act in the circumstances you specify in this appointment or, if you do not specify any circumstances, in the circumstances specified in section 93(2)(b) of the Act.

Section 93(2)(b) provides that your alternative supportive attorney(s) will be authorised to act in the following circumstances: if the supportive attorney for whom the alternative supportive attorney is appointed (i) dies; or (ii) does not have decision making capacity for the matter(s) to which the appointment applies; or (iii) is otherwise not willing or able to act; or (iv) the power given to them is revoked because they have become insolvent under administration, or they have become a care worker, health provider or accommodation provider for you, or, in the case of a supportive attorney for financial matters, they are convicted or found guilty of an offence involving dishonesty.

Circumstances in which alternative supportive attorney(s) are authorised to act

If you have appointed one or more alternative supportive attorneys, and are specifying the circumstances in which you are authorising the alternative supportive attorney(s) to act, complete the following section. If you do not want to specify the circumstances in which you are authorising the alternative supportive attorney(s) to act or you have not appointed an alternative supportive attorney, cross out this section.

I authorise my alternative supportive attorney(s) to act in the circumstances described below:

[Insert details]

2. AUTHORISATION

I authorise my supportive attorney(s) to exercise the following power(s):

Tick the option(s) as to the powers you are giving.

Information power: to access, collect or obtain from, or assist me in accessing, collecting or obtaining from, any person any personal information about me that: (a) is relevant to a supported decision; and (b) may lawfully be collected or obtained by me.

Communication power: to communicate any information about me that is relevant or necessary to the making of or giving effect to a supported decision, or to communicate or assist me to communicate a supported decision.

Power to give effective to decisions: to take any reasonable action or to do anything that is reasonably necessary to give effect to a supported decision, other than a decision about a significant financial transaction.

If you are appointing more than one supportive attorney, specify which power(s) are to be given to which supportive attorney(s) otherwise cross out this section.

STATE OF VICTORIA


APPOINTMENT OF SUPPORTIVE ATTORNEYSTATE OF VICTORIA


I authorise my supportive attorney(s) to exercise these powers in relation to the following matters:

Tick one box, and only one.

personal matters

financial matters

personal and financial matters

other matters

[Specify details of other matters]

If not authorising the supportive attorney(s) to exercise power for all personal/financial/other matters, specify the matter(s) and the supportive attorney(s) to whom the matter(s) apply below, otherwise cross out this section.

3. COMMENCEMENT

This supportive attorney appointment commences:

Tick box, and only one. If no option is chosen, the supportive attorney appointment commences immediately.

immediately on the making of the power

from the following time, in the following circumstance or, on the following occasion: If choosing this option, specify the time from which, circumstance in which, or occasion on which the appointment is to commence.



Signed

[Signature of principal or person signing at the direction of (on behalf of) the principal]

Date [Principal or person signing at the direction of (on behalf of) the principal to write the date here]

Tick the following option if the supportive attorney appointment is being signed by a person at the direction of the principal.

I sign this supportive attorney appointment at the direction of and in presence of the principal. Name of person signing at direction of principal

Address of person signing at direction of principal



CERTIFICATE OF WITNESSES

Witnessed by

Name of first witness [Insert full name of first witness]

Address of first witness [Insert residential address of first witness]

Name of second witness [Insert full name of second witness]

Address of second witness [Insert residential address of second witness]

Each witness certifies under section 98 of the Powers of Attorney Act 2014 that:

Tick either Option A or Option B below.

If witnessing for the principal signing, tick this option.

Option A • the principal appeared to freely and voluntarily sign this instrument in our presence; • at that time, the principal appeared to us to have decision making capacity in relation to the

making of this supportive attorney appointment; • we are not supportive attorneys under this supportive attorney appointment; • we are not relatives of the principal or of an attorney under this supportive attorney

appointment; and • we are not care workers or accommodation providers for the principal.

If witnessing another person signing at the direction and in the presence of the principal, tick this option.

Option B • we are not the person who is signing at the direction of the principal; • in our presence, the principal appeared to freely and voluntarily direct the person to sign for the

principal and that person signed this instrument in our presence and in the presence of the principal; • at that time, the principal appeared to us to have decision making capacity in

relation to the making of this supportive attorney appointment; • we are not supportive attorneys under this supportive attorney appointment; • we are not relatives of the principal or of an attorney under this supportive attorney appointment; and • we are not care workers or accommodation providers for the principal.

Signed

First witness [Signature of first witness]

Qualification of first witness [Insert qualification of first witness if acting as a person authorised to witness statutory declarations]

Second witness [Signature of second witness]

Qualification of second witness [Insert qualification of second witness if acting as a person authorised to witness statutory declarations]

Date [Insert date]



STATEMENT OF ACCEPTANCE OF APPOINTMENT: SUPPORTIVE ATTORNEY

Note: Each attorney must sign a statement of acceptance and it must be witnessed separately, as set out below.

The supportive attorney or, if there is more than one supportive attorney, the first supportive attorney, completes this section.

Name of supportive attorney [Insert full name of supportive attorney]

Address of supportive attorney [Insert residential address of supportive attorney]

I accept my appointment as supportive attorney under this supportive attorney appointment and state that:

- I am eligible under the Powers of Attorney Act 2014 to act as a supportive attorney under a supportive attorney appointment; and

- I understand the obligations of a supportive attorney under the Powers of Attorney Act 2014 and the consequences of failing to comply with the Powers of Attorney Act 2014; and

- I undertake to act in accordance with the Powers of Attorney Act 2014.



Signed

Date [Supportive attorney to sign] [Insert date]

Witnessed by



I witnessed the signing of the statement of acceptance by the supportive attorney.

Signed


The second supportive attorney, if any, completes this section.

Name of supportive attorney [Insert full name of second supportive attorney]

Address of supportive attorney [Insert residential address of second supportive attorney]

I accept my appointment as supportive attorney under this supportive attorney appointment and state that:


- I understand the obligations of a supportive attorney under the Powers of Attorney Act 2014 and the consequences of failing to comply with the Powers of Attorney Act 2014; and

- I undertake to act in accordance with the Powers of Attorney Act 2014.



Signed

Date [Second supportive attorney to sign] [Insert date]

Witnessed by



I witnessed the signing of the statement of acceptance by the supportive attorney.

Signed






STATEMENT OF ACCEPTANCE OF APPOINTMENT: ALTERNATIVE SUPPORTIVE ATTORNEY

Note: If you are appointing one or more alternative supportive attorneys, each alternative supportive attorney must sign a statement of acceptance and it must be witnessed separately in the supportive attorney appointment form, as set out below.

Your alternative supportive attorney, or your first alternative supportive attorney, completes this section.

Name of alternative supportive attorney [Insert full name of alternative supportive attorney]

Address of alternative supportive attorney

[Insert residential address of alternative supportive attorney]

I accept my appointment as an alternative supportive attorney under this supportive attorney appointment and state that:


- I understand the obligations of a supportive attorney under the Powers of Attorney Act 2014 and the

consequences of failing to comply with the Powers of Attorney Act 2014; and

- I undertake to act in accordance with the Powers of Attorney Act 2014; and

- I understand the circumstances in which the alternative supportive attorney is authorised to act under the Powers of Attorney Act 2014; and

- I am prepared to act in place of the supportive attorney for whom I am appointed when authorised to do so under the Powers of Attorney Act 2014.



Signed

Date [Alternative supportive attorney to sign] [Insert date]

Witnessed by



I witnessed the signing of the statement of acceptance by the alternative supportive attorney.

Signed




The second alternative supportive attorney, if any, completes this section.

Name of alternative supportive attorney [Insert full name of second alternative supportive attorney]

Address of alternative supportive attorney [Insert residential address of second alternative supportive attorney]

I accept my appointment as alternative supportive attorney under this supportive attorney appointment and state that:


- I understand the obligations of a supportive attorney under the Powers of Attorney Act 2014 and the

consequences of failing to comply with the Powers of Attorney Act 2014; and

- I undertake to act in accordance with the Powers of Attorney Act 2014; and

- I understand the circumstances in which the alternative supportive attorney is authorised to act under the Powers of Attorney Act 2014; and

- I am prepared to act in place of the supportive attorney for whom I am appointed when authorised to do so under the Powers of Attorney Act 2014.



Signed

Date [Second alternative supportive attorney to sign] [Insert date]

Witnessed by



I witnessed the signing of the statement of acceptance by the alternative supportive attorney.

Signed


staple all sheets for form 1 together here enduring … · victoria form 1 enduring power of...

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