Informal Decision Maker Details Form-0071

INFORMAL DECISION MAKER DETAILS (Form-0071)
Please use this form to advise us of arrangements you have with a family member or close friend who helps you make decisions (i.e. personal, lifestyle or financial matters) This person may be a member of your family or a close friend. If an informal decision-maker supports you to make decisions, you are requested to complete this form providing contact details for that person and describing the nature of the agreement between you.
Your Contact Details
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState

Postal Code
Phone:
Contact Details of your Informal Decision Maker
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState

Postal Code
Phone:
Email:
example@example.com
How would you prefer to be contacted? E.g. Phone, SMS, email. You may choose more than one.
Agreement:
Your First Name Your Last Name agrees that Decision-Maker First Name Decision-Maker Last Name
May speak on my behalf and represent my best interests to Skymac about lifestyle decisions in regard to my tenancyMay speak on my behalf and represent my best interests to Skymac about financial decisions in regard to my tenancy (e.g. rent payment)May speak on my behalf and represent my best interests regarding consent and additional service forms.May view my Resident Personal File which includes mail I've received, Public Trust information and appointment records.
The first point of contact to discuss matters relating to the above should be:

MeMy informal decision maker
This agreement is valid from Date to Datefor a maximum period of 5 years.
Declaration and Signatures:
Your signature:

Clear
Date:

DayMonthYear
Informal Decision Maker's signature:

Clear
Date:

DayMonthYear
Should be Empty:

INFORMAL DECISION MAKER DETAILS (Form-0071)

Declaration and Signatures: