Appointment of Enduring Guardian

1
Background information

An enduring guardianship appointment is an important document. It allows someone else to make medical and lifestyle decisions on your behalf. You should get legal or medical advice (or both) before you sign it.

It is important that you trust the person you appoint as your enduring guardian to make appropriate lifestyle decisions on your behalf. It is recommended you inform this person of your wishes about lifestyle decisions and involve them in discussions about your views or goals. If these change, it is important to let your enduring guardian know.

An enduring guardian can only make lifestyle decisions such as health decisions. You should make an enduring Power of Attorney if you want someone to make financial decisions on your behalf if you lose capacity.

If you appoint more than one enduring guardian, you should indicate whether the enduring guardians are to act jointly, severally or jointly and severally. Enduring guardians who are appointed jointly are only able to make decisions if they all agree about the decision. Enduring guardians who are appointed severally or jointly and severally are able to make decisions independently of each other.

If you appoint a substitute enduring guardian, they will only have authority to act as your guardian if the first appointed enduring guardian/s dies, resigns or becomes incapacitated.

Each enduring guardian must sign their acceptance on the appointment for it to be effective.
If someone signs the appointment on your behalf, they must be at least 18 years old. They must not be the person being appointed as an enduring guardian. They cannot also witness the execution of the appointment.

If you marry after you appoint an enduring guardian then the appointment will automatically be revoked (unless you married your enduring guardian).

Your enduring guardian can resign at any time, by giving you notice in writing. If you have lost capacity to make decisions at that time then your enduring guardian can only resign with the approval of the Civil and Administrative Tribunal.

Enduring guardianship appointments are not automatically accessible on any public register. Therefore, it is important that key people are aware of the appointment so they can contact the enduring guardian if required. You should provide a copy of the enduring guardianship appointment to your enduring guardian and keep a copy in a safe place. You should also let close friends or family know about it and give a copy to your solicitor, doctor and health service provider.

For further information about enduring guardianship, contact the NSW Trustee and Guardian, the Office of the Public Guardian or the Civil and Administrative Tribunal.
2
Appointor's NameThe person needing their financial affairs managed.
First Name
Last Name
3
Appointor's Email
example@example.com
4
Appointor's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
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Argentina
Armenia
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Australia
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The Bahamas
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Christmas Island
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Costa Rica
Cote d'Ivoire
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Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
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Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Are you appointing more than one Enduring Guardian?Answer 'no' for a single Enduring Guardian.
YESNO
6
1. Appointment of Enduring Guardian(s)

I, {appointorsName}
of {appointorsAddress}

(“Principal”)

appoint

{detailsOf[1]}

of

{detailsOf[2]}

to be my Enduring Guardian ('Enduring Guardian').
7
Details of 2 Enduring Guardian
Full Name of Enduring Guardian
Address of Enduring Guardian
8
1. Appointment of Enduring Guardian(s)

I, {appointorsName}
of {appointorsAddress}

(“Principal”)

appoint

1. {detailsOf[1]}

of

{detailsOf[2]}

and also appoint

{detailsOf117[1]}

of

{detailsOf117[2]}

to be my Enduring Guardians ('Enduring Guardians').
9
Are you nominating a Alternative Guardian?Answer 'no', if no further appointments.
YESNO
10
Details of Alternative Guardian
Full Name of Alternative Guardian
Address of Alternative Guardian
11
ALTERNATIVE GUARDIAN (optional)

[If your Enduring Guardian vacates office, you have the option to nominate someone else to take their place.]

If my Enduring Guardian(s) vacate/s office, I {appointorsName} of {appointorsAddress}
appoint:

{detailsOf120[1]}

of

{detailsOf120[2]}

to be my alternative Enduring Guardian/s.
(“Alternative Guardian(s)”).
12
How I wish my Enduring Guardians to act (OPTIONAL): Complete this section only if more than one Enduring Guardian has been appointed. I appoint my Enduring Guardians to act:
(A) JOINTLY (your Enduring Guardians must all act together).
(B) SEVERALLY (Your Enduring Guardians may act individually).
(C) JOINTLY AND SEVERALLY (Your Enduring Guardians may act individually or can act together with the other Enduring Guardians, if they choose).
13
The death, resignation or incapacity of any of my joint enduring guardians does/does not terminate the appointment of each of my other joint enduring guardians.
14
Functions and limits of my Enduring Guardian(s)

I authorise my enduring guardian(s) to exercise the following functions:
(a) to decide where I live,
I place the following limits on the authority of my enduring guardian(s):

Insert any limits

(b) to decide what health care I receive,
I place the following limits on the authority of my enduring guardian(s):

Insert any limits

(c) to decide what other kinds of personal services I receive,
I place the following limits on the authority of my enduring guardian(s):

Insert any limits

(d) to consent to the carrying out of medical or dental treatment on me (in accordance with Part 5 of the Guardianship Act 1987),
I place the following limits on the authority of my enduring guardian(s):

Insert any limits

(e) to decide:

Insert any additional functions and limits
15
OPTIONAL - DIRECTIONS TO MY ENDURING GUARDIANSThe functions of my Enduring Guardian(s) must be exercised in accordance with the following directions:
Huge
Large
Normal
Small
Ok
Ok
16
COMMENCEMENTTHIS ENDURING GUARDIANSHIP OPERATES: (Tick the option that applies)
Once the Enduring Guardian/s have accepted his/her appointment by signing this document.
Once a medical practitioner considers that I am unable to manage my affairs (and provides a document to that effect).
Once my Enduring Guardian considers that I need assistance managing my affairs.
If no option is selected or the options chosen are unclear or inconsistent, I intend that the Enduring Guardianship will operate once my Enduring Guardian/s have accepted their appointment by signing this document.
Other
17
Is the Appointor signing this document?Select 'No', if someone else is signing in their behalf.
YESNO
18
Date
Date
Month
Day
Year
19
Appointor's Signature
Powered by Jotform SignClear
20
Appointor's signature to make appointment

{appointorsSignature}

{appointorsName}

{date}
21
Date
Date
Year
Month
Day
22
Signing on behalf of Appointor
Full name of person signing on behalf of appointor
Address of the person signing on behalf of appointor
Please enter your phone
Please enter your email
23
Signature on behalf of AppointorThe Appointor instructed me to sign this appointment on their behalf.
Powered by Jotform SignClear
24
Signing On behalf of Appointor

{signatureOn}

{date71}

The Appointor instructed me to sign this appointment on their behalf.

Here are my details:

{signingOn[1]}

of

{signingOn[2]}

Phone: {signingOn[3]}

Email: {signingOn[4]}
25
Signature of Enduring GuardianAcceptance
Powered by Jotform SignClear
26
Date
Date
Year
Month
Day
27
Acceptance by Enduring Guardian

I,

{detailsOf[1]}

of

{detailsOf[2]}

accept my appointment as an Enduring Guardian.

{signatureOf}

{date124}
28
Signature of second Enduring GuardianAcceptance
Powered by Jotform SignClear
29
Date
Date
Year
Month
Day
30
Acceptance by second Enduring Guardian

I,

{detailsOf117[1]}

of

{detailsOf117[2]}

accept my appointment as an Enduring Guardian.

{signatureOf126}

{date127}
31
Details of Prescribed witness
Full Name of prescribed witness
Address of prescribed witness
Occupation of Prescribed witness
32
Certificate of Witness - Appointor & Guardian

I,   {detailsOf131[1]}
of {detailsOf131[2],
{detailsOf131[3],

(Australian legal practitioner/Registrar of the Local Court/overseas-registered foreign lawyer/approved employee of NSW Trustee and Guardian or the Office of the Public Guardian)
certify that:
(a)      {appointorsName}    appeared to understand the effect of this instrument and in my presence:
(i) executed the instrument voluntarily, and
(b)     {detailsOf[1]}   appeared to understand the effect of this instrument and in my presence executed the instrument voluntarily.

Signature

Date
33
Certificate of Witness - Person on behalf Appointor & Guardian

I,   {detailsOf131[1]}
of {detailsOf131[2],
{detailsOf131[3],

(Australian legal practitioner/Registrar of the Local Court/overseas-registered foreign lawyer/approved employee of NSW Trustee and Guardian or the Office of the Public Guardian)
certify that:
(a)     {appointorsName}     appeared to understand the effect of this instrument and in my presence:
(i) executed the instrument voluntarily, or
(ii) voluntarily instructed   {signingOn[1]}      to sign the instrument on his behalf and that person executed the instrument in my presence, and
(b)    {detailsOf[1]}    appeared to understand the effect of this instrument and in my presence executed the instrument voluntarily.

Signature

Date
34
Certificate of Witness - Appointor & Guardians

I,   {detailsOf131[1]}
of {detailsOf131[2],
{detailsOf131[3],

(Australian legal practitioner/Registrar of the Local Court/overseas-registered foreign lawyer/approved employee of NSW Trustee and Guardian or the Office of the Public Guardian)
certify that:
(a)       {appointorsName}   appeared to understand the effect of this instrument and in my presence:
(i) executed the instrument voluntarily, and
(b)      {detailsOf[1]}    appeared to understand the effect of this instrument and in my presence executed the instrument voluntarily, and
(c)      {detailsOf117[1]}  appeared to understand the effect of this instrument and in my presence executed the instrument voluntarily.

Signature

Date
35
Certificate of Witness - Person on behalf of Appointor & Guardians

I,   {detailsOf131[1]}
of {detailsOf131[2],
{detailsOf131[3],

(Australian legal practitioner/Registrar of the Local Court/overseas-registered foreign lawyer/approved employee of NSW Trustee and Guardian or the Office of the Public Guardian)
certify that:
(a)        {appointorsName}  appeared to understand the effect of this instrument and in my presence:
(i) executed the instrument voluntarily, or
(ii) voluntarily instructed   {signingOn[1]}     to sign the instrument on his behalf and that person executed the instrument in my presence, and
(b)      {detailsOf[1]}  appeared to understand the effect of this instrument and in my presence executed the instrument voluntarily, and
(c)     {detailsOf117[1]} appeared to understand the effect of this instrument and in my presence executed the instrument voluntarily.

Signature

Date
36
Signature of Alternative Enduring GuardianAcceptance
Powered by Jotform SignClear
37
Date
Date
Year
Month
Day
38
Acceptance by Alternative Enduring Guardian

I,

{detailsOf120[1]}

of

{detailsOf120[2]}

accept my appointment as an Alternative Enduring Guardian.

{signatureOf129}

{date130}
39
Certificate of Witness - Alternative Enduring Guardian's

I,   {detailsOf131[1]}
of {detailsOf131[2],
{detailsOf131[3],

(Australian legal practitioner/Registrar of the Local Court/overseas-registered foreign lawyer/approved employee of NSW Trustee and Guardian or the Office of the Public Guardian)
certify that:
(a)     {appointorsName}     appeared to understand the effect of this instrument and in my presence:
(i) executed the instrument voluntarily, or
(ii) voluntarily instructed   {signingOn[1]}    to sign the instrument on his behalf and that person executed the instrument in my presence, and
(b)    {detailsOf120[1]} appeared to understand the effect of this instrument and in my presence executed the instrument voluntarily.

Signature

Date
40
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Online Appointment of Enduring GuardianOnline Appointment of Enduring Guardian
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