Signatures of alternate signer and witnesses
(To be used only when the grantor is unable to sign the Enduring Power of Attorney and there is an alternate signer of the document.)
________________________________________________
__________________________________
(Signature of alternate signer)
(date)
Statement of Witness:
I, _________________________________________________________________________________________________________ ,
(name)
of _________________________________________________________________________________________________________
(street address)
(city)
(province)
(postal code)
certify:
(a) that ______________________________________________________________________________________________
(name of alternate signer)
signed this Enduring Power of Attorney in my presence;
(b) that ______________________________________________________________________________________________
(name of grantor)
acknowledged the signature of the alternate signer in my presence;
(c) that I am an adult with capacity and I am not the personal attorney or a member of the personal attorney’s
family or a member of the grantor’s family;
(d) that I am signing this Enduring Power of Attorney as a witness in the presence of the grantor.
________________________________________________
__________________________________
(Signature of witness)
(date)
Other witness signatures
(note that one of the witnesses may be the same person that witnessed the alternate signing)
________________________________________________
__________________________________
(Signature of witness)
(date)
________________________________________________
__________________________________
(Signature of second witness if first witness is not a lawyer)
(date)
(If witnessed by a lawyer, attach Form D - Legal Advice and Witness Certificate. If witnessed by two adults, attach Form E - Non-lawyer Witness
Certificate.)
10. Acceptance of Appointment
(optional)
I accept the appointment as personal attorney and I will exercise my authority honestly, in good faith and in
the best interests of the grantor.
________________________________________________
__________________________________
(Signature of personal attorney)
(date)
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