Power Of Attorney Instructions

Please tick the document you want us to prepare for you*
- Enduring Power of Attorney
- Non-Enduring Power of Attorney
- Medical Treatment Decision Maker
Full name (including middle names)*
Date of birth*
Date Format: MM slash DD slash YYYY
Phone number*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Attorney
Full name (including middle names)*
Date of birth*
Date Format: MM slash DD slash YYYY
Phone number*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you want to appoint a second attorney:*
- Yes
- No
Secondary Attorney Full Name*
Date*
Date Format: MM slash DD slash YYYY
Phone number*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Specific Instructions
When is the Power of Attorney to start?
- Immediately
- If I am unable to make my own decision’s
- On a particular date
If on a particular date, what date would you like it to start?
Any limitations or conditions on appointing your Attorneys?
Any other instructions

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