Form A Enduring A Power Of Attorney Appointing A Personal Attorney
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4FORM A
[Clause 3(a)]
SAVE AS
Enduring Power of Attorney Appointing a Personal Attorney
This form is to be used as a guide to the appointment of a personal attorney. A personal attorney has authority with respect to your personal affairs.
He or she does not have authority with respect to your property and financial affairs. He or she does not have authority with regard to health care
decisions, which are governed by The Health Care Directives and Substitute Health Care Decision Makers Act.
Include in your Enduring Power of Attorney only those parts of the form that are applicable to your situation.
This Enduring Power of Attorney is given on _________________________________________________________________
(date)
by ________________________________________________________________________________________________________
(name of grantor)
of _________________________________________________________________________________________________________
(street address)
(city)
(province)
(postal code)
(check as appropriate)
1. Appointment
(choose one)
(a) I appoint _____________________________________________________________________________________
(name of personal attorney)
of _____________________________________________________________________________________________________
(street address)
(city)
(province)
(postal code)
to act as my personal attorney in accordance with The Powers of Attorney Act, 2002.
or
(b) I appoint ____________________________________________________________________________________
(name of personal attorney)
of _____________________________________________________________________________________________________
(street address)
(city)
(province)
(postal code)
and ___________________________________________________________________________________________________
(name of personal attorney)
of _____________________________________________________________________________________________________
(street address)
(city)
(province)
(postal code)
(you may appoint two or more persons)
to act as my personal attorneys in accordance with The Powers of Attorney Act, 2002:
jointly
(your personal attorneys will act together)
severally
(your personal attorneys will act separately and independently, in accordance with the authority given to them)
successively
(your personal attorneys will act in order of appointment)
Optional:
If it is or becomes necessary for the purposes of subsection 6(2) of the Act:
I acknowledge that _____________________________________________________________________________________
(name of personal attorney)
has been convicted of a criminal offence relating to assault, sexual assault or other acts of violence, intimidation,
criminal harassment, uttering threats, theft, fraud or breach of trust; and
I consent to this person acting as my personal attorney.
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