Enduring Power of Attorney – Western Australia

Enduring Power of Attorney – Western Australia
Order Form

1Donor

2Attorney(s)

3Substituted Attorney(s)

4Conditions & Restrictions

5Commencement

6Revocation of POA

7Payment

Donor
The Donor is the person who is appointing the attorney/attorneys under the Enduring Power of Attorney.
Full Name*
First Middle Last
Alias (if any)
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attorney(s)
The Attorney(s) are the person or persons the Donor wishes to appoint as their Attorney.

Note: You may only appoint up to two attorneys.
Attorney 1
Full Name*
First Middle Last
Alias (if any)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to the Donor*
Please specify*
- Add Another Attorney
Attorney 2
Full Name*
First Middle Last
Alias (if any)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to the Donor*
Please specify*
Attorney(s) to Act*
- Jointly
- Jointly and Severally

Substituted Attorney 1
Full Name
First Middle Last
Alias (if any)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to the Donor
Please specify*
Substituted Attorney for
Substituted Attorney to Act
- My original Attorney is unable to act due to death or lack of capacity, or at any time my original Attorney is temporarily unable to act due to illness or personal commitments (Note: if you have appointed only one original Attorney and are appointing two subsitutes to replace the original Attorney).
- If either of my original Attorneys is unable to act due to death or lack of capacity or either original Attorney is temporarily unable to act due to illness or personal commitments. (Note: if you have appointed two original Attorneys and are appointing one substitute to replace the original Attorneys).
Note: If you wish your substitute Attorney(s) to act in place of the original Attorney(s) during some other event or time (i.e. other than the option provided above) please contact us.
- Add Another Substitute Attorney
Substitute Attorney 2
Full Name*
First Middle Last
Alias (if any)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to the Donor
Please specify*
Substituted Attorney for*
- My original Attorney is unable to act due to death or lack of capacity, or at any time my original Attorney is temporarily unable to act due to illness or personal commitments (Note: if you have appointed only one original Attorney and are appointing two subsitutes to replace the original Attorney).
- If either of my original Attorneys is unable to act due to death or lack of capacity or either original Attorney is temporarily unable to act due to illness or personal commitments. (Note: if you have appointed two original Attorneys and are appointing one substitute to replace the original Attorneys).
Note: If you wish your substitute attorney(s) to act in place of the original attorney(s) during some other event or time (i.e. other than the option provided above) please contact us.
Manner*
- Jointly
- Jointly and Severally

Payment
Service Fee*
Price:
inclusive of GST
Payment Option*
- Pay now
- I already have a direct debit agreement established with SuperGuardian
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Email
Untitled

Disclaimer: Any information that is financial product advice is provided by SuperGuardian Pty Ltd (AFSL No. 485643 ). The advice provided is general in nature and is not personal financial product advice. The advice provided has been prepared without taking into account your objectives, financial situation or needs and because of this you should, before acting on it, consider the appropriateness of it having regard to your objectives, financial situation and needs. You should carefully read and consider any product disclosure statement that is relevant to any financial product that has been discussed before making any decision about whether to acquire the financial product. Please refer to SuperGuardian FSG https://www.superguardian.com.au/pdfs/Financial-Services-Guide.pdf for contact information.

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Donor

Attorney(s)

Attorney 1

Attorney 2

Substituted Attorney 1

Substitute Attorney 2

Conditions & Restrictions of Appointment

Commencement

Revocation of Power of Attorney

Payment