Powers of Attorney Amendment Regulations 2017
Authorised by the Chief Parliamentary Counsel
Authorised Version
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Powers of Attorney Amendment Regulations 2017
S.R. No. 17/2017
TABLE OF PROVISIONS
Regulation Page
1 Objective 1
2 Authorising provision 1
3 Commencement 1
4 Principal Regulations 2
5 Schedule 1—Form 1 substituted 2
6 Schedule 1—Form 2 substituted 6
7 Schedule 1—Form 4 substituted 8
8 Schedule 1—Form 5 substituted 9
9 Schedule 1—Form 6 substituted 13
10 Schedule 1—Form 7 substituted 14
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Endnotes 15
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Authorised by the Chief Parliamentary Counsel
Authorised Version
1
STATUTORY RULES 2017
S.R. No. 17/2017
Powers of Attorney Act 2014
Powers of Attorney Amendment Regulations 2017
The Lieutenant-Governor as the Governor's deputy, with the
advice of the Executive Council, makes the following
Regulations:
Dated: 12 April 2017
Responsible Minister:
MARTIN PAKULA
Attorney-General
ANDREW ROBINSON
Clerk of the Executive Council
1 Objective
The objective of these Regulations is to
make amendments to the Powers of Attorney
Regulations 2015 as a consequence of the
enactment of the Powers of Attorney
Amendment Act 2016 and for other matters.
2 Authorising provision
These Regulations are made under section 139 of
the Powers of Attorney Act 2014.
3 Commencement
These Regulations come into operation on
1 May 2017.
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4 Principal Regulations
In these Regulations, the Powers of Attorney
Regulations 20151 are called the Principal
Regulations.
5 Schedule 1—Form 1 substituted
For Form 1 in Schedule 1 to the Principal
Regulations substitute—
"FORM 1
ENDURING POWER OF ATTORNEY
Regulation 5
Name of principal:
Address of principal:
APPOINTMENT
I appoint [insert name of one or more persons or position] of
[insert address(es) of persons or position]
*to be my attorney
*to be my joint attorneys
*to be my several attorneys
*to be my joint and several attorneys
*to be my majority attorneys
*and I appoint [insert name of one or more persons or position] of
[insert address(es) of persons or position] as alternative attorney for
[insert name of one attorney].
*and I appoint [insert name of one person or position] of [insert address of
person or position] as alternative attorney for [insert names of more than
one attorney].
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.
AUTHORISATION
I authorise my attorney(s):
*to do anything on my behalf that I can lawfully do by an attorney.
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*to do anything on my behalf that I can lawfully do by an attorney for—
∗ personal matters only.
∗ financial matters only.
∗ the following specified matters:
*REVOCATION
*I specify that the enduring power of attorney made by me on [insert date
made if known] is not revoked by this enduring power of attorney.
*I specify that the following parts of the enduring power of attorney made by
me on [insert date made if known] are not revoked by this 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 in the later enduring power
of attorney.
Under sections 152 and 153 of the Act, an enduring power of
attorney is taken to include an existing enduring power of attorney
made under the Instruments Act 1958 and an existing appointment
of an enduring guardian made under the Guardianship and
Administration Act 1986.
COMMENCEMENT
The powers under this enduring power of attorney for all matters are
exercisable:
*immediately on the making of this enduring power of attorney.
*when I cease to have decision making capacity for the matter(s).
*from the time, in the circumstance or on the occasion specified as follows:
*CONDITIONS AND INSTRUCTIONS
The exercise of power under this enduring power of attorney is subject to
the following conditions or instructions:
Signed: [signature of principal or person signing at the direction of
(on behalf of) the principal]
*I sign this enduring power of attorney at the direction of and in the presence
of the principal.
*Name of person signing at direction of principal:
*Address of person signing at direction of principal:
Date:
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CERTIFICATE OF WITNESSES
Witnessed by:
Name of first witness:
Address of first witness:
Name of second witness:
Address of second witness:
Each witness certifies that:
*the principal appeared to freely and voluntarily sign this instrument in my
presence; and
*[If witnessing another person signing at the direction of and in the presence
of the principal] 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.
*[If witnessing another person signing this enduring power of attorney at the
direction of and in the presence of the principal] I am not the person who is
signing at the direction of the principal.
Signed:
First witness: [signature of first witness]
*Qualification: [if first witness is acting as a medical practitioner or person
authorised to witness affidavits]
Second witness: [signature of second witness]
*Qualification: [if second witness is acting as a medical practitioner or
person authorised to witness affidavits]
Date:
STATEMENT OF ACCEPTANCE OF APPOINTMENT—ATTORNEY
Name of attorney:
Address of attorney:
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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] I have disclosed to the principal
that I have been convicted or found guilty of an offence involving dishonesty.
Signed: [signature of attorney]
Date:
*Position: [if appointed as the occupant of a position]
Witnessed by:
Name of witness:
Address of witness:
I witnessed the signing of the statement of acceptance by the attorney.
Signed: [signature of witness]
Date:
Note: Each attorney must sign a statement of acceptance and it must be
witnessed separately in the enduring power of attorney.
STATEMENT OF ACCEPTANCE OF APPOINTMENT—
ALTERNATIVE ATTORNEY
Name of alternative attorney:
Address of alternative attorney:
I accept my appointment as an alternative 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
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• I undertake to act in accordance with the provisions of the Powers of
Attorney Act 2014 that relate to enduring powers of attorney; and
• 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.
*[If appointed for financial matters and you have been convicted or found
guilty of an offence involving dishonesty] I have disclosed to the principal
that I have been convicted or found guilty of an offence involving dishonesty.
Signed: [signature of alternative attorney]
Date:
*Position: [if appointed as the occupant of a position]
Witnessed by:
Name of witness:
Address of witness:
I witnessed the signing of the statement of acceptance by the alternative
attorney.
Signed: [signature of witness]
Date:
Note: Each alternative attorney must sign a statement of acceptance and it
must be witnessed separately in the enduring power of attorney.
*Delete if not applicable.".
6 Schedule 1—Form 2 substituted
For Form 2 in Schedule 1 to the Principal
Regulations substitute—
"FORM 2
REVOCATION BY PRINCIPAL OF ENDURING POWER
OF ATTORNEY OR APPOINTMENT OF
ATTORNEY/ALTERNATIVE ATTORNEY
Regulation 6
Name of principal:
Address of principal:
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I revoke under section 44 of the Powers of Attorney Act 2014:
*the enduring power of attorney made by me on [insert date made].
*the appointment of my attorney(s) [insert name (or position) of one or more
attorneys] of [insert address(es) of attorney(s)] under the enduring power of
attorney made by me on [insert date made].
*the appointment of my alternative attorney(s) [insert name (or position) of
one or more alternative attorneys] of [insert address(es) of alternative
attorney(s)] for [insert name of attorney(s)] under the enduring power of
attorney made by me on [insert date made].
Signed: [signature of principal or person signing at the direction of
(on behalf of) the principal]
*I sign this instrument of revocation in the presence of and at the direction of
the principal.
*Name of person signing at direction of principal:
*Address of person signing at direction of principal:
Date:
CERTIFICATE OF WITNESSES
Witnessed by:
Name of first witness:
Address of first witness:
Name of second witness:
Address of second witness:
Each witness certifies that:
*the principal appeared to freely and voluntarily sign this instrument in my
presence; and
*[If witnessing another person signing at the direction of and in the
presence of the principal] 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 to revoke 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 the enduring
power of attorney; and
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• I am not a care worker or accommodation provider for the principal.
*[If witnessing another person signing at the direction of and in the presence
of the principal] I am not the person who is signing at the direction of the
principal.
Signed:
First witness: [signature of first witness]
*Qualification: [if first witness is acting as a medical practitioner or person
authorised to witness affidavits]
Second witness: [signature of second witness]
*Qualification: [if second witness is acting as a medical practitioner or
person authorised to witness affidavits]
Date:
*Delete if not applicable.".
7 Schedule 1—Form 4 substituted
For Form 4 in Schedule 1 to the Principal
Regulations substitute—
"FORM 4
RESIGNATION BY ATTORNEY OR ALTERNATIVE
ATTORNEY
Regulation 8
Name (or position) of attorney or alternative attorney resigning:
Address of attorney or alternative attorney resigning:
*I resign/*The trustee company resigns under section *56/*59(1)(a)/
*59(1)(b)/*59(3) of the Powers of Attorney Act 2014 from *my/*its
appointment as an *attorney/*alternative attorney for [insert name
(or position) of attorney(s)] under the enduring power of attorney made by
[insert name of principal] on [insert date made (if known)].
Signed: [signature of attorney or alternative attorney]
Date:
*Delete if not applicable.".
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8 Schedule 1—Form 5 substituted
For Form 5 in Schedule 1 to the Principal
Regulations substitute—
"FORM 5
APPOINTMENT OF SUPPORTIVE ATTORNEY
Regulation 9
Name of principal:
Address of principal:
APPOINTMENT
I appoint [insert name of one or more supportive attorney] of
[insert address(es) of supportive attorney(s)] to act as my supportive
attorney(s)
*and I appoint [insert name(s) of one or more alternative supportive
attorney] of [insert address(es) of alternative supportive attorney(s)]
as alternative supportive attorney for [insert name of one supportive
attorney].
*and I appoint [insert name of one alternative supportive attorney] of
[insert address of alternative supportive attorney] as alternative supportive
attorney for [insert names of more than one supportive attorney].
AUTHORISATION
I authorise my supportive attorney(s) to exercise the following power(s):
*Information power in accordance with section 87 of the Powers of
Attorney Act 2014.
*Communication power in accordance with section 88 of the Powers of
Attorney Act 2014.
*Power to give effect to decisions in accordance with section 89 of the
Powers of Attorney Act 2014.
I authorise my supportive attorney(s) to exercise these powers in relation to
the following matters:
*personal matters
*financial matters
*both personal and financial matters
*the following personal, financial or other matters only: [specify]
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COMMENCEMENT
This supportive attorney appointment commences:
*on its making.
*from the time, in the circumstance or on the occasion specified as follows:
Signed: [signature of principal or person signing at the direction of
(on behalf of) the principal]
*I sign this supportive attorney appointment at the direction of and in the
presence of the principal.
*Name of person signing at direction of principal:
*Address of person signing at direction of principal:
Date:
CERTIFICATE OF WITNESSES
Witnessed by:
Name of first witness:
Address of first witness:
Name of second witness:
Address of second witness:
Each witness certifies that:
*the principal appeared to freely and voluntarily sign this supportive attorney
appointment form in my presence; and
*[If witnessing another person signing at the direction of (on behalf of) and
in the presence of the principal] in my presence, the principal appeared to
freely and voluntarily direct the person to sign for the principal and that
person signed this supportive attorney appointment form 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 making this supportive attorney appointment.
Each witness states that:
• I am not a supportive attorney under this appointment.
*[If witnessing another person signing this supportive attorney appointment
form at the direction of (on behalf of) and in the presence of the principal]
I am not the person who is signing at the direction of the principal.
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Signed:
First witness: [signature of first witness]
*Qualification: [if first witness is acting as a person authorised to witness
statutory declarations]
Second witness: [signature of second witness]
*Qualification: [if second witness is acting as a person authorised to witness
statutory declarations]
Date:
STATEMENT OF ACCEPTANCE OF APPOINTMENT—
SUPPORTIVE ATTORNEY
Name of supportive attorney:
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.
*[If appointed for financial matters and you have been convicted or found
guilty of an offence involving dishonesty] I have disclosed to the principal
that I have been convicted or found guilty of an offence involving dishonesty.
Signed: [signature of supportive attorney]
Date:
Witnessed by:
Name of witness:
Address of witness:
I witnessed the signing of the statement of acceptance by the supportive
attorney.
Signed: [signature of witness]
Date:
Note: Each supportive attorney must sign a statement of acceptance and it
must be witnessed separately in the supportive attorney appointment.
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STATEMENT OF ACCEPTANCE OF APPOINTMENT—
ALTERNATIVE SUPPORTIVE ATTORNEY
Name of alternative supportive attorney:
Address of alternative supportive attorney:
I accept my appointment as an alternative 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;
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.
*[If appointed for financial matters and you have been convicted or found
guilty of an offence involving dishonesty] I have disclosed to the principal
that I have been convicted or found guilty of an offence involving dishonesty.
Signed: [signature of alternative supportive attorney]
Date:
Witnessed by:
Name of witness:
Address of witness:
I witnessed the signing of the statement of acceptance by the alternative
supportive attorney.
Signed: [signature of witness]
Date:
Note: Each alternative supportive attorney must sign a statement of
acceptance and it must be witnessed separately in the supportive
attorney appointment.
*Delete if not applicable.".
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9 Schedule 1—Form 6 substituted
For Form 6 in Schedule 1 to the Principal
Regulations substitute—
"FORM 6
REVOCATION BY PRINCIPAL OF SUPPORTIVE
ATTORNEY APPOINTMENT OR APPOINTMENT OF
SUPPORTIVE ATTORNEY/ALTERNATIVE
SUPPORTIVE ATTORNEY
Regulation 10
Name of principal:
Address of principal:
I revoke under section 103 of the Powers of Attorney Act 2014:
*the supportive attorney appointment made by me on [insert date made].
*the appointment of my supportive attorney(s) [insert name of supportive
attorney or attorneys if revoking the appointment of more than one] of
[insert address(es) of supportive attorney(s)] under the supportive attorney
appointment made by me on [insert date made].
*the appointment of my alternative supportive attorney(s) [insert name of
alternative supportive attorney or attorneys if revoking the appointment of
more than one] of [insert address(es) of alternative supportive attorney(s)]
for [insert name of supportive attorney(s)] under the supportive attorney
appointment made by me on [insert date made].
Signed: [signature of principal or person signing at the direction of
(on behalf of) the principal]
*I sign this instrument of revocation at the direction of and in the presence of
the principal.
*Name of person signing at direction of principal:
*Address of person signing at direction of principal:
Date:
Witnessed by: [signature of witness]
Name of witness:
Address of witness:
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Qualification: [specify how authorised to witness the signing of a statutory
declaration]
Date:
*Delete if not applicable.".
10 Schedule 1—Form 7 substituted
For Form 7 in Schedule 1 to the Principal
Regulations substitute—
"FORM 7
RESIGNATION BY SUPPORTIVE ATTORNEY OR
ALTERNATIVE SUPPORTIVE ATTORNEY
Regulation 11
Name of supportive attorney or alternative supportive attorney resigning:
Address of supportive attorney or alternative supportive attorney resigning:
I resign under section 111 of the Powers of Attorney Act 2014 from my
appointment as *a supportive attorney/*an alternative supportive attorney
for [insert name of supportive attorney(s)] under the supportive attorney
appointment made by [insert name of principal] on [insert date made
(if known)].
Signed: [signature of supportive attorney or alternative supportive attorney
resigning]
Date:
*Delete if not applicable.".
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Endnotes
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Endnotes
1 Reg. 4: S.R. No. 93/2015.
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