Powers of Attorney Regulations 2015

Authorised by the Chief Parliamentary Counsel Authorised Version i Powers of Attorney Regulations 2015 S.R. No. 93/2015 TABLE OF PROVISIONS Regulation Page Part 1—Preliminary 1 1 Objective 1 2 Authorising provisions 1 3 Commencement 1 4 Definition 1 Part 2—Prescribed forms 2 5 Enduring power of attorney 2 6 Revocation by principal of enduring power of attorney or appointment of attorney/alternative attorney 2 7 Notification by attorney 2 8 Resignation by attorney or alternative attorney 2 9 Appointment of supportive attorney 2 10 Revocation by principal of supportive attorney appointment or appointment of supportive attorney/alternative supportive attorney 3 11 Resignation by supportive attorney or alternative supportive attorney 3 Schedule 1—Forms 4 ═══════════════ -- 1 of 20 -- Authorised by the Chief Parliamentary Counsel Authorised Version 1 STATUTORY RULES 2015 S.R. No. 93/2015 Powers of Attorney Act 2014 Powers of Attorney Regulations 2015 The Governor in Council makes the following Regulations: Dated: 11 August 2015 Responsible Minister: MARTIN PAKULA Attorney-General YVETTE CARISBROOKE Clerk of the Executive Council Part 1—Preliminary 1 Objective The objective of these Regulations is to prescribe forms and other matters for the purposes of the Powers of Attorney Act 2014. 2 Authorising provisions These Regulations are made under section 139 of the Powers of Attorney Act 2014. 3 Commencement These Regulations come into operation on 1 September 2015. 4 Definition In these Regulations— the Act means the Powers of Attorney Act 2014. -- 2 of 20 -- Part 2—Prescribed forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 2 Authorised by the Chief Parliamentary Counsel Part 2—Prescribed forms 5 Enduring power of attorney (1) For the purposes of section 32 of the Act, the prescribed form is Form 1 of Schedule 1. (2) For the purposes of section 37 of the Act, the prescribed form of statement of acceptance is the statement of acceptance of appointment—attorney in Form 1 of Schedule 1. (3) For the purposes of section 38 of the Act, the prescribed form of statement of acceptance is the statement of acceptance of appointment— alternative attorney in Form 1 of Schedule 1. 6 Revocation by principal of enduring power of attorney or appointment of attorney/alternative attorney For the purposes of section 45 of the Act, the prescribed form is Form 2 of Schedule 1. 7 Notification by attorney For the purposes of section 54(5) of the Act, the prescribed form is Form 3 of Schedule 1. 8 Resignation by attorney or alternative attorney (1) For the purposes of section 57 of the Act, the prescribed form is Form 4 of Schedule 1. (2) For the purpose of section 60 of the Act, the prescribed form is Form 4 of Schedule 1. 9 Appointment of supportive attorney (1) For the purposes of section 94 of the Act, the prescribed form is Form 5 of Schedule 1. (2) For the purposes of section 99 of the Act, the prescribed form of statement of acceptance is the statement of acceptance of appointment— supportive attorney in Form 5 of Schedule 1. -- 3 of 20 -- Part 2—Prescribed forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 3 Authorised by the Chief Parliamentary Counsel (3) For the purposes of section 100 of the Act, the prescribed form of statement of acceptance is the statement of acceptance of appointment— alternative supportive attorney in Form 5 of Schedule 1. 10 Revocation by principal of supportive attorney appointment or appointment of supportive attorney/alternative supportive attorney For the purposes of section 104 of the Act, the prescribed form is Form 6 of Schedule 1. 11 Resignation by supportive attorney or alternative supportive attorney For the purposes of section 112 of the Act, the prescribed form is Form 7 of Schedule 1. -- 4 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 4 Authorised by the Chief Parliamentary Counsel Schedule 1—Forms FORM 1 ENDURING POWER OF ATTORNEY Regulation 5 This enduring power of attorney is made under Part 3 of the Powers of Attorney Act 2014 and has effect as a deed under section 81 of the Act. Name of principal: Address of principal: APPOINTMENT I appoint [insert name (or position) of attorney or attorneys if appointing more than one] of [insert address(es) of attorney(s)] *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 *I specify that all previous enduring powers of attorney made by me under the Powers of Attorney Act 2014 are revoked [specify if otherwise]. 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. *and I appoint [insert name of alternative attorney or alternative attorneys if appointing more than one] of [insert address(es) of alternative attorney(s)] as alternative attorney for [insert name of attorney for whom alternative attorney is appointed]. 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. -- 5 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 5 Authorised by the Chief Parliamentary Counsel AUTHORISATION 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 not authorising the attorney(s) to exercise power for all personal or financial matters, specify 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.] OR *to do anything on my behalf that I can lawfully do by an attorney (see section 22(1) of the Act). COMMENCEMENT The powers under this enduring power of attorney for all matters are exercisable: [Choose one option only. If no option is chosen the power is exercisable immediately.] *immediately on the making of this enduring power of attorney *when I cease to have decision making capacity for the matter(s) *other time, circumstance or occasion: [specify time, circumstance or occasion when the power is exercisable] [If power for a specified matter(s) is exercisable at a different time, circumstance or occasion to other matter(s) in the enduring power of attorney, specify the matter(s) and when exercisable.] *CONDITIONS AND INSTRUCTIONS 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] *I sign this enduring power of attorney at the direction of and in the presence of the principal. -- 6 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 6 Authorised by the Chief Parliamentary Counsel *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 our presence; and *[If witnessing another person signing at the direction of and in the presence 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; and • at that time, the principal appeared to us to have decision making capacity in relation to the making of this enduring power of attorney; and • we are not attorneys under this enduring power of attorney; and • 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 this enduring power of attorney at the direction of and in the presence of the principal] we are 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] -- 7 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 7 Authorised by the Chief Parliamentary Counsel 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: 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: 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. -- 8 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 8 Authorised by the Chief Parliamentary Counsel 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 • 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: 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. -- 9 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 9 Authorised by the Chief Parliamentary Counsel FORM 2 REVOCATION BY PRINCIPAL OF ENDURING POWER OF ATTORNEY OR APPOINTMENT OF ATTORNEY/ALTERNATIVE ATTORNEY Regulation 6 Name of principal: Address of principal: 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 attorney or attorneys if revoking the appointment of more than one] of [insert address(es) of attorney(s) (if known)] under the enduring power of attorney made by me on [insert date made]. *the appointment of my alternative attorney(s) [insert name of alternative attorney or alternative attorneys if revoking the appointment of more than one] of [insert address(es) of alternative attorney(s) (if known)] 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 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: -- 10 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 10 Authorised by the Chief Parliamentary Counsel Each witness certifies under section 49 of the Powers of Attorney Act 2014 that: ∗the principal appeared to freely and voluntarily sign this instrument in our presence; and ∗[If witnessing another person signing at the direction of and in the presence 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; and • at that time, the principal appeared to us to have decision making capacity to revoke this enduring power of attorney; and • we are not attorneys under this enduring power of attorney; and • we are not relatives of the principal or of an attorney under the enduring power of attorney; and • we are not care workers or accommodation providers for the principal; and ∗[If witnessing another person signing at the direction of and in the presence of the principal] we are 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. -- 11 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 11 Authorised by the Chief Parliamentary Counsel FORM 3 NOTIFICATION BY ATTORNEY Regulation 7 To: [insert name of person(s) or organisation(s) to whom notice is being given] of [insert address(es) of person(s) or organisation(s) to whom notice is being given (if known)] This notice is given under section 54 of the Powers of Attorney Act 2014. * INDIVIDUAL Name of attorney giving notice: Address of attorney giving notice: I give notice that my appointment as an attorney under the enduring power of attorney made by [insert name of principal] on [insert date made (if known)] is revoked because: ∗ I have become an insolvent under administration. ∗ I have become a care worker, health or accommodation provider for the principal. ∗ [If an attorney for financial matters] I have been convicted or found guilty of an offence involving dishonesty. * TRUSTEE COMPANY Name of trustee company giving notice: Address of trustee company giving notice: The company, an attorney under the enduring power of attorney made by [insert name of principal] on [insert date made (if known)] gives notice that: ∗ the company's appointment as an attorney under that enduring power of attorney is revoked because the company has been wound up or ceased to be registered. ∗ a proceeding for winding up has commenced against the company. ∗ the company has been convicted or found guilty of an offence involving dishonesty. Signed: [signature of attorney] Date: *Delete if not applicable. -- 12 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 12 Authorised by the Chief Parliamentary Counsel FORM 4 RESIGNATION BY ATTORNEY OR ALTERNATIVE ATTORNEY Regulation 8 Name 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 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: Note: Section 56 of the Powers of Attorney Act 2014 applies if the principal has decision making capacity. Section 59 of the Powers of Attorney Act 2014 applies if the principal does not have decision making capacity. *Delete if not applicable. -- 13 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 13 Authorised by the Chief Parliamentary Counsel FORM 5 APPOINTMENT OF SUPPORTIVE ATTORNEY Regulation 9 This supportive attorney appointment is made under Part 7 of the Powers of Attorney Act 2014. Name of principal: Address of principal: APPOINTMENT I appoint [insert name of supportive attorney or attorneys if appointing more than one] of [insert address(es) of supportive attorney(s)] to act as my supportive attorney(s) *and I appoint [insert name of alternative supportive attorney or alternative supportive attorneys if appointing more than one] of [insert address(es) of alternative supportive attorney(s)] as alternative supportive attorney for [insert name of supportive attorney for whom alternative supportive attorney is appointed]. 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. AUTHORISATION I authorise my supportive attorney(s) to exercise the following power(s): *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 -- 14 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 14 Authorised by the Chief Parliamentary Counsel *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 effect 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 more than one supportive attorney is appointed, specify which power(s) are to be given to which supportive attorney(s).] 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 *other matters: [specify] [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.] COMMENCEMENT This supportive attorney appointment commences: [Choose one option only. If no option is chosen the supportive attorney appointment commences on its making.] *on its making *other time, circumstance or occasion: [specify the time, circumstance or occasion when the appointment is to commence] 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: -- 15 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 15 Authorised by the Chief Parliamentary Counsel 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 our presence; and *[If witnessing another person signing at the direction of (on behalf of) and in the presence 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 supportive attorney appointment form in our presence and in the presence of the principal; and • at that time, the principal appeared to us to have decision making capacity in relation to making this supportive attorney appointment. Each witness states that: • we are not supportive attorneys 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] we are 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 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: -- 16 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 16 Authorised by the Chief Parliamentary Counsel 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(s) must sign a statement of acceptance and it must be witnessed separately in the supportive attorney appointment. -- 17 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 17 Authorised by the Chief Parliamentary Counsel 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. -- 18 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 18 Authorised by the Chief Parliamentary Counsel 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)(if known)] 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) (if known)] 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: Qualification: [specify how authorised to witness the signing of a statutory declaration] Date: *Delete if not applicable. -- 19 of 20 -- Schedule 1—Forms Powers of Attorney Regulations 2015 S.R. No. 93/2015 19 Authorised by the Chief Parliamentary Counsel 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 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: Note: A person who resigns as a supportive attorney or an alternative supportive attorney under section 111 of the Powers of Attorney Act 2014 must take all reasonable steps to inform the principal and any other supportive attorney and alternative supportive attorney of the resignation: see section 113 of the Powers of Attorney Act 2014. *Delete if not applicable. ═══════════════ -- 20 of 20 --