Will Questionnaire

Power of Attorney Questionnaire

Health Care Directive Questionnaire

Advice Following
the Signature of Your Will

Power of Attorney Questionnaire

A Power of Attorney is a binding legal document which allows you to appoint another individual to act as your attorney (any person appointed by you_ in order to manage your affairs when you are incapacitated or otherwise unable to do so yourself. A Power of Attorney will be effective from the date that it is executed, but may not be used without your express authority or, in the event that you become incapacitated.

Your Name -

Full Name and Address of Person(s) to be appointed your Attorney:

If you are appointing more than one, do you want them both required to sign or is the signature of either one to be sufficient:

- Both
- Either one

Is the Power of Attorney to be acted upon immediately or only upon proof of mental incapacity?

- Immediately
- Upon proof of incapacity

Completing this form does not constitute a valid Power of Attorney. The information will be used to complete a Power of Attorney for you which will become valid once properly executed.