Quote Form What is this form for?The purpose of this form is to provide the information we need to help us draft a simple or complex will for you. What is the difference between a simple will or complex will? A simple or standard Will starts from $290. A complex will is where you might require our advice on how to best structure your estate, including but not limited to someone with a blended family; separated or divorced; leaving a dependent out; a trust; unusual specific gifts; or companies, business or trust structures. Our complex will price depends on the complexity of your Will, please complete this form and we will contact you with a price. What is a simple Will? A Simple Will is a Will when you are single or in a married/de fact relationship, would like to leave all of your assets to one person and if they don't survive you then to your other dependents or someone else. It's not a simple will if you intend on leaving anyone that would be entitled to claim on your estate out, or if you want to do complex estate structures or divisions of assets. I don't know what to do or what I want? You can do anything you want with your property when you die - it's your stuff after all. This simple will kit is designed to cater for a will the majority of people choose, that is, to give everything to their spouse and then to their children if their spouse is no longer alive. If you want to do something different with your estate, that's no problem, just let us know and we can talk about it. Fill out this form anyway as it will give us important information, and then give us a call for a chat. I'm ready You should set aside 10-15 minutes to complete this form, once completed we will contact you and confirm our quote. What happens next? After you complete this form we will ring and confirm your quote, if you are happy to proceed we will use all of this information to draft your Will. Once we've drafted your Will, you can come into our office to sign it. Your DetailsName* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone* Please nominate your preference below if you have one:* It is my wish that I be cremated It is my wish that I be buried Do you have a previous will? Yes No Please upload a copy of your photo ID Drop files here or Select files Max. file size: 128 MB. Please include a licence or a passport with a clear photo.Do you have children? Yes biological Step Children No Children Marital Status Married De facto partner Divorced Separated Single The executor is in charge of getting all your assets together and distributes your assets to your beneficiaries. You should choose someone you trust as your executor who will faithfully follow your wishes. Would you like to appoint your spouse as executor?* Yes No Spouse Name First Middle Last Apart from , would you like to appoint another executor for your will?* Yes No Why have a second executor? We recommend you appoint at least two executors. In case one person can't act and the other person needs to step in. Executor DetailsThe executor is in charge of getting all your assets together and distributes your assets to your beneficiaries. You should choose someone you trust as your executor who will faithfully follow your wishes. Who do appoint as your executor?* First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Why have a second executor? We recommend you appoint at least two executors. In case one person can't act and the other person needs to step in. You don't have to complete this section, but we highly recommend it. Would you like to appoint another executor for your will?* Yes No Second ExecutorWho do appoint as your executor?* First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are myHow would you like them to make their decisions?* Joint - and each have to agree about decisions with your estate Substitute - is only the executor if is unable or unwilling to be your executor for eg they have passed away Would you like to appoint another executor?* Yes No Third ExecutorWho do appoint as your executor?* First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are myHow would you like them to make their decisions? Joint - , and each have to agree about decisions with your estate Substitute - is only the executor if and are unwilling or unable to act Substitute and Joint - AND are to act together as executors if is unwilling or unable to act What is my estate? Your estate is all the property you owned before you died, including all of your assets and debts. Your executor is in charge of getting all of your assets together, paying off your debts and then distributing your estate to your beneficiaries. You should be aware that your will cannot deal with certain assets like super. You will need to do a binding death benefit with your super fund to ensure your super is distributed in line with your wishes. Please contact us to discuss preparation of a binding death benefit. After any specific gifts have been made in your will and debts are paid off, the residue is everything that is left in your estate. A simple will usually provides that your residue is to be divided equally between your children after some specific gifts have been made. Would you like to leave everything to your spouse? Yes, and if they don't survive me than to someone else (for eg children, brother or sister, whoever else) No, I would like to split my estate between people including my spouse I want to leave me spouse out of my estate completely ChildrenDo you intend to include all of your children in your estate? Yes No Are any of your childen under 18* Yes No Age your children inheritAged 18Aged 21Aged 25If your children are minors when they would expect to receive a gift under this will, your executor will hold their gift on trust until they reach an age as specific by you. Who and why do you intend for them to be left out of your estate? In this next page you will list your beneficiaries in the case that has passed away BeneficiariesYour beneficiaries of your estate are the people who you are gifting your property to via your will. In this simple will, your spouse (if you have one) will receive everything and be the primary beneficiary of your estate. If you survive your spouse (ie out-live them) then your children will become the beneficiaries of your estate in equal shares.Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add second beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add third beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add fourth beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add fifth beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add sixth beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add seventh beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add eighth beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add ninth beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my Add tenth beneficiary Percentage Share %Name First Middle Last Relationship to yousondaughterbrothersisterfriendmotherfathercousinauntyuncleniecenephewotherFor eg they are my SuperannuationSuperannuation Interests are not usually dealt with under your will. They are dealt with according to a binding death benefit nomination which is given to your fund. We can prepare these and send them to your super fund. The interest can be given straight to a person you choose or can be given to your executor to be dealt with under your will. Sometimes, they need to be updated every few years. Please let us know if you want us to do this for you. We will not act on this unless specific instructions are given. I understand Superannuation is not dealt with under the will and I need to contact my superannuation fund Specific GiftsWhat are specific gifts? Specific gifts are those that get removed from the residue of your estate, for eg. I want to give my gold diamond ring to John Smith my son or I want to give the elephant painting to my neighbor, or I want to give $5000 to my nephew.Would you like to make any specific gifts?First nameMiddle nameLast nameRelationshipGift details If you would like to make any specific gifts, such as gifts of specific property or cash sums, please name the beneficiary here and describe the gift. For example: 'Timothy Robert Smith' 'Son' 'My gold ring.' 'Bruce Robert Smith' 'Son' '$10,000 cash.' Guardianship of ChildrenDo you want to appoint a guardian for your children in the event you and your spouse die? Yes No Guardian Name First Middle Last Would you like your will stored in Safe Custody? Yes No Please let us know if you would like us to store your will in safe custody. This will incur an additional fee of $25. We will always scan your signed will and keep an electronic copy on file (but the courts often require the original). Other options are you keep the will in a safe place or give it to a trusted friend.Other instructions?Please let us know if you have any other instructions with respect to your gifts/beneficiaries (which might not have been covered above). Please tick any that you think might apply in your circumstance if any of the following apply, extra charges may be be added to your quote Charitable clause Urgent Will (less than 76 hour turn around) Discretionary Testamentary Trust is required Self managed superannuation fund exists Superannuation Nomination Form is required Family Trust or Company Trust exists Children from a previous relationship exists Protective disability trust is required Leaving a spouse (if still married or if in de facto relationship) out of the Will Leaving a child out of the Will Non standard clauses Another important document in an estate plan is an enduring power of attorney. This is an extra document, that is used while you're still alive but need someone to make decisions for you and act on your behalf for some reason. For eg, you are in a car accident and don't have the capacity to pay a bill but need someone to do it.Would you like to create an Enduring Power of Attorney?* Yes No What is an enduring power of attorney? Power of attorney is the legal power to make decisions on someone else's behalf. ‘Enduring’ simply means that the power continues even if the person giving it loses the capacity to make decisions. Why do people appoint attorneys? There are some circumstances in which you may be unable to make decisions about matters that concern you. For example, you may be overseas, or you may be too ill. If you give someone a general power of attorney, for instance to sign documents for you in your absence, that power will come to an immediate end if for some reason you lose your capacity to make decisions. This could be very awkward if your attorney is in the process of conducting business affairs for you. Giving someone enduring power means that he/she is able to continue to act for you if you lose capacity to act for yourself. What can an attorney do? You may give your attorney power to make decisions about personal/health matters and/or financial matters. Examples of personal/health matters are decisions about where and with whom you live, whether you work or undertake education or training, whether you apply for a licence or permit, day-to-day issues like diet and dress, and whether to consent, refuse to consent or withdraw consent to particular types of health care for you (such as an operation). An example of a financial matter is deciding how your income should be invested. Note:You cannot give your attorney power to make decisions about special personal matters such as a decision about your will, appointing someone as your attorney, voting at elections, or consenting to adoption or marriage; or special health matters, such as donation of body tissue, sterilisation, pregnancy termination, research or experimental health care, or certain psychiatric or other health care as specified in the regulations. Your attorney can consent to the withdrawing or withholding of life-sustaining medical treatment if, for instance, you become terminally ill or go into a state of permanent or persistent unconsciousness. You can give instructions about this type of decision if you make an Advance Health Directive. These instructions will override any decision of your attorney. Can I limit my Attorney's Powers? Yes, you can specify decisions that you do not want your attorney to make. You can also include particular instructions about what you would like your attorney to do. Your attorney must act in accordance with your instructions. There are also limits set by legislation. For example, the Trust Act names the types of investment that a trustee (in this case your attorney) is authorised to make. If you lose the capacity to make financial decisions, the only investments your attorney can make on your behalf are those that are named in the Act, unless the consent of the Court is obtained. Can I appoint more than one attorney? Yes. Several options are provided for in the Act. For example, you may appoint two or more attorneys to act jointly (together), or as a majority (simple, two-thirds, etc.), or severally (any one of your attorneys can sign), or successively (power is given to a particular attorney when the power given to another attorney ends, or when the other attorney is not available to make decisions). If you choose two or more attorneys to make decisions jointly, they have equal authority and can act only with the agreement of them all. If one attorney dies, the remaining attorneys exercise the power. It is important that your intentions be expressed clearly. There is space in this document to appoint up to three attorneys. Who should I appoint as my attorney? You should appoint someone you trust. Many people choose their spouse or an adult child, but you may prefer to appoint another family member or friend with expertise in the area, or the Adult Guardian for personal/health matters, or the Public Trustee or a trustee company for all matters. (The Adult Guardian is appointed by statute to look after the rights and interests of people with disabilities and, in certain situations, to give health-care consent.) Your attorney must be over eighteen years of age, must not be your current paid carer or health-care provider (such as your nurse or your doctor), and (for financial matters) must not be bankrupt or insolvent. Note: ‘Paid carer’ does not mean someone receiving a carer's pension or similar benefit, so you are free to choose someone who is receiving such a benefit for looking after you. Should I pay my attorney? You do not need to pay your attorney for the power to be effective. Normally payment is not made unless a trust company is acting as attorney. When does the attorney's power begin? With personal/health matters, your attorney's power to make decisions does not begin until (if ever) you are incapable of understanding the nature and foreseeing the effects of a decision, and of communicating that decision. With financial matters, you may nominate when your attorney's power is to begin. If you do not name a date or an occasion, it begins immediately. On the other hand, if you lose the capacity to make such decisions before the date or occasion you name, the power begins at that point. Note: Even if you give your attorney power immediately, you may also continue to make decisions yourself while you are able to do so. How much control will the attorney have? Once the power to make a decision begins, your attorney will have full control over that decision unless you have explicitly limited that power in this document. Note: It is better not to place too many restrictions on your attorney's power, as this may make it difficult for your attorney to make decisions on your behalf. How long does the power continue? For personal/health matters, it continues so long as you are incapable of understanding the nature and foreseeing the effects of a decision, and of communicating that decision. With financial matters, it continues until it is revoked. How can I be sure that my attorney will act in my interests? While (if ever) you are unable to oversee your attorney's decisions, the Adult Guardian and the Court have the power to protect your interests. Your attorney may be required to produce a summary of receipts and expenditure or more detailed accounts, and these may be audited. An attorney who does not adequately protect your interests can be removed or changed. Can I change or revoke a power of attorney? Yes, you may change or revoke it at any time, so long as you are capable of understanding what you are doing. In other words, so long as you have the capacity to make an enduring power of attorney, you also have the capacity to change or revoke it. If you do change or revoke this power, you must inform your attorney. Is there anything else that will end this power? Yes, several other circumstances will bring this enduring power of attorney to an end: If you get married. If you marry, the power of attorney is revoked unless your new spouse is already your attorney. (If your new spouse is your attorney, the only power that is revoked is the power of any other attorney you may have.) If you get divorced. If you divorce, the power of attorney is revoked to the extent that it was given to your former spouse. If you die. If you die, the enduring power of attorney is revoked in its entirety. If you make an inconsistent document. This power is revoked to the extent of any inconsistency with any later document you complete, such as an Advance Health Directive or another enduring power of attorney. If your attorney withdraws. Your attorney may withdraw by giving you a signed notice or by getting the Court's leave to withdraw. If your attorney becomes your paid carer or health-care provider. If this happens, your attorney's power is revoked. If your attorney becomes incapable. Your attorney's power is revoked if he/she becomes incapable of understanding the nature and foreseeing the effects of a decision, and of communicating that decision. If your attorney becomes bankrupt or insolvent. If your attorney dies. Power of attorneyWho would you like to make your attorney? First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneWould you like to appoint two Power of Attorney's?* Yes No Second Power of AttorneyWho else would you like to appoint as your power of attorney? First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneHow do you want your power of attorneys to act? Individually (only one person is required to act on your behalf) Jointly (both must agree before acting on my behalf) You can appoint more than one person to serve as your power of attorney representative. However, you should be sure to specify whether they can act individually or whether they must act jointly. For example, Is the signature of either your son or daughter sufficient (individually) or do you want the signatures of both your son and daughter to convey your consent (jointly)Final NotesYou are appointing your attorney for the following powers: Financial Matters Personal/Health Matters Financial and personal/health matters. Do you want to set any terms for the power given in clause 1 (i.e. give specific information about your wishes)? Yes No Questions? Concerns or comments?If you have further instructions for the power of attorney please put them here.