Enduring Power of Attorney for Care & Welfare

Enduring Power of Attorney for Care & Welfare

An Enduring Power of Attorney (EPA) for personal care and welfare is a legal document that gives someone you trust the power to make decisions about your health and welfare if you’re unable to. We recommend you grab a cuppa as this may take 30 minutes to complete.

A) Your Personal Details

In an EPA the person creating the EPA is referred to as the "Donor".
Your Full Name:

PrefixFirst NameMiddle NameLast Name
Your Email:
example@example.com

B) Previous EPAs

If you have one (1) or more previous EPAs in relation to your personal care and welfare, you may choose to revoke them, or specify that they will continue. If you specify here that you want a previous EPA to continue, you need to make sure the authority to act under the previous EPA is not inconsistent with your Attorney(s) authority to act under this EPA, otherwise it may not be clear what each Attorney’s duties are. If the EPAs relate to different matters in relation to your personal care and welfare, this will not be a problem.
Do you have a previous EPA for your personal care and welfare?

I do not have any previous EPA(s).I revoke all previous EPAs in relation to my personal care and welfare that I may have given.I want to continue only the previous EPAs in relation to my personal care and welfare that are specified below.
List details of any personal care and welfare EPA that is to continue. If none, you may leave the space blank or specify “None”.

C) Attorney

Under the EPA for your personal care and welfare, you may only appoint one Attorney to act at a time. Please provide the details of whom you wish to be your Attorney for your personal care and welfare in the first instance. Your Attorney can be anyone you trust to understand and respect your wishes and feelings and who is able to make decisions about your personal care and welfare, provided they are aged 20 or older, not bankrupt, and not mentally incapable themselves. Usually, this is a friend, family member, or work colleague. Preferably, your Attorney should live in the same area as you so that they can attend personally to your care and welfare.
Attorney Full Name:

PrefixFirst NameMiddle NameLast Name
Attorney relationship to me:
i.e. my husband / my wife / my partner / my brother / my sister / my daughter / my son etc.
Attorney Email:
example@example.com
Attorney Phone:

Area CodePhone Number
Attorney Physical Address:

Street Address

Suburb

CityState / Province

Postal / Zip CodeCountry
If you have a copy of your Attorney's Passport or Drivers Licence, please upload here (optional):

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D) What Your Attorney(s) Can Act On

Your Attorney can act for you on all matters relating to your personal care and welfare, or only some matters. If you want your Attorney to act on only some matters, you must list what those matters are.
My Attorney(s) can act on my behalf on:

My Attorney can act on my behalf on all of my personal care and welfare matters.My Attorney can act of my behalf on only the matters relating to my personal care and welfare that I have listed below.
Specify the matters that your Attorney can act on. If you selected that your Attorney can act on your behalf on all matters, you may leave the space blank or specify “None”.

E) Conditions & Restrictions

You can state any conditions or restrictions you wish to place on your Attorney’s authority to act.
My Attorneys conditions and restrictions:

My Attorneys authority to act is not subject to any conditions or restrictions.My Attorneys authority to act is subject to the following conditions or restrictions below.
List any conditions or restrictions. If none, you may leave the space blank or specify “None”.

F) First Successor Attorney

If your Attorney in the first instance is unable to act, you have the option to name someone to be your First Successor Attorney. A First Successor Attorney will act as your Attorney only if your original Attorney is unable to act.
Appointment of a First Successor Attorney:

If the appointment of the Attorney named in section C ends, I appoint as my First Successor Attorney the person named below.I do not wish to appoint any Successor Attorneys.
If you selected that you do not wish to appoint a First Successor Attorney, click "Next". If you selected that you wish to appoint a First Successor Attorney, provide their details below.
First Successor Attorney Full Name:

PrefixFirst NameMiddle NameLast Name
First Successor Attorney relationship to me:
i.e. my husband / my wife / my partner / my brother / my sister / my daughter / my son etc.
First Successor Attorney Email:
example@example.com
Type a question
First Successor Attorney Phone:

Area CodePhone Number
First Successor Attorney Physical Address:

Street Address

Suburb

CityState / Province

Postal / Zip CodeCountry
If you have a copy of your First Successor Attorney's Passport of Drivers Licence, please upload here (optional):

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G) Second Successor Attorney

If your Attorney in the first instance and your First Successor Attorney is unable to act, you have the option to name someone to be your Second Successor Attorney. A Second Successor Attorney will act as your Attorney only if your original Attorney and First Successor Attorney is unable to act.
Appointment of a Second Successor Attorney:

If the appointment of the Attorney named in section C and my First Successor Attorney end, I appoint as my Second Successor Attorney the person named below.I do not wish to appoint any Second Successor Attorneys.
If you selected that you do not wish to appoint a Second Successor Attorney, click "Next". If you selected that you wish to appoint a Second Successor Attorney, provide their details below.
Second Successor Attorney Full Name:

PrefixFirst NameMiddle NameLast Name
Second Successor Attorney relationship to me:
i.e. my husband / my wife / my partner / my brother / my sister / my daughter / my son etc.
Second Successor Attorney Email:
example@example.com
Second Successor Attorney Phone:

Area CodePhone Number
Second Successor Attorney Physical Address:

Street Address

Suburb

CityState / Province

Postal / Zip CodeCountry
If you have a copy of your Second Successor Attorney's Passport of Drivers Licence, please upload here (optional):

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H) Consultation

You have the option to name one (1) or more people who, as far as is practicable, your Attorney must seek advice from (consult) about your personal care and welfare before making decisions. Your Attorney can consult only on the matters you specified in section D. This form allows for two (2) names, but you can name as many people as you like. You also have the option to limit the consultation requirement to your successor Attorney(s).
Appointment of Consultants:

My Attorneys are not required to consult with anyone about my personal care and welfare matters before making decisions.My Attorneys are required to consult with the person(s) named below about the matters I have indicated.
If you selected that your Attorney(s) are not required to consult with anyone, click "Next". If you selected that your Attorneys are required to consult, provide details below.
Duty to Consult:

The duty to consult applies to both my Attorney and my Successor Attorney(s).The duty to consult applies to my Successor Attorney(s) only.
Provide the details of the person(s) you wish to be consulted:
Consultant One Full Name:

PrefixFirst NameMiddle NameLast Name
Consultant One relationship to me:
i.e. my husband / my wife / my partner / my brother / my sister / my daughter / my son etc.
Consultant One Email:
example@example.com
Consultant One Phone:

Area CodePhone Number
Consultant One must be consulted about:

Consultant One must be consulted about all my personal care and welfare matters listed in section D.Consultant One must be consulted about only the matters relating to my personal care and welfare listed below.
If you selected option two, provide the personal care and welfare matters that Consultant One must be consulted about:
Consultant One Physical Address:

Street Address

Suburb

CityState / Province

Postal / Zip CodeCountry
Consultant Two Full Name:

PrefixFirst NameMiddle NameLast Name
Consultant Two relationship to me:
i.e. my husband / my wife / my partner / my brother / my sister / my daughter / my son etc.
Consultant Two Email:
example@example.com
Consultant Two Phone:

Area CodePhone Number
Consultant Two Physical Address:

Street Address

Suburb

CityState / Province

Postal / Zip CodeCountry
Consultant Two must be consulted about:

Consultant Two must be consulted about all my personal care and welfare matters listed in section D.Consultant Two must be consulted about only the matters relating to my personal care and welfare listed below.
If you selected option two, provide the personal care and welfare matters that Consultant Two must be consulted about:
Provide details of further Consultants (if any):

I) Providing Information

You have an option to name one (1) or more people to keep an eye on your Attorney’s actions. This form allows for two (2) names, but you can name as many people as you like. Your Attorney must provide them with the information (as listed) about how they are carrying out their EPA duties. This information must be provided straight away when requested.
Appointment of person(s) to provide information to:

My Attorney is not required to provide information to anyone about how they are carrying out my personal care and welfare matters.My Attorney must give to the person(s) I have named below the information I have indicated.
If you selected that your Attorney(s) are not required to provide information to anyone, click "Next". If you selected that your Attorneys are required to provide information, provide details below.
Information Person One Full Name:

PrefixFirst NameMiddle NameLast Name
Information Person One relationship to me:
i.e. my husband / my wife / my partner / my brother / my sister / my daughter / my son etc.
Information Person One Email:
example@example.com
Information Person One Phone:

Area CodePhone Number
Information Person One Physical Address:

Street Address

Suburb

CityState / Province

Postal / Zip CodeCountry
Information to be provided to Information Person One:

My Attorney must give Person One information on all decisions of my Attorney.My Attorney must give Person One information relating to the below.
If you selected option two, provide the personal care and welfare information that Information Person One must be provided:
Information Person Two Full Name:

PrefixFirst NameMiddle NameLast Name
Information Person Two relationship to me:
i.e. my husband / my wife / my partner / my brother / my sister / my daughter / my son etc.
Information Person Two Email:
example@example.com
Information Person Two Phone:

Area CodePhone Number
Information Person Two Physical Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Information to be provided to Information Person Two:

My Attorney must give Person Two information on all decisions of my Attorney.My Attorney must give Person Two information relating to the below.
If you selected option two, provide the personal care and welfare information that Information Person Two must be provided:

J) Additional Terms & Conditions
You have the option to specify additional terms and conditions of your EPA.

My Attorneys are not subject to any additional terms and conditions.My Attorneys are subject to the following additional terms and conditions:
If you selected option two, provide us with the additional terms and conditions for your EPA:
You are now finished. Please review your form and click "submit" once you are happy. If you are also wanting a Property EPA, please ensure you have completed that form. We will be in touch soon. Thank you.
Should be Empty:

Enduring Power of Attorney for Care & Welfare

A) Your Personal Details

B) Previous EPAs

C) Attorney

D) What Your Attorney(s) Can Act On

E) Conditions & Restrictions

F) First Successor Attorney

If you selected that you do not wish to appoint a First Successor Attorney, click "Next". If you selected that you wish to appoint a First Successor Attorney, provide their details below.

G) Second Successor Attorney

If you selected that you do not wish to appoint a Second Successor Attorney, click "Next". If you selected that you wish to appoint a Second Successor Attorney, provide their details below.

H) Consultation

If you selected that your Attorney(s) are not required to consult with anyone, click "Next". If you selected that your Attorneys are required to consult, provide details below.

Provide the details of the person(s) you wish to be consulted:

I) Providing Information

If you selected that your Attorney(s) are not required to provide information to anyone, click "Next". If you selected that your Attorneys are required to provide information, provide details below.

J) Additional Terms & Conditions

You are now finished. Please review your form and click "submit" once you are happy. If you are also wanting a Property EPA, please ensure you have completed that form. We will be in touch soon. Thank you.