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Power of Attorney/Financial Manager
A person can appoint another person Power of Attorney to execute documents and conduct financial and property matters on their behalf. Alternatively, a formal Financial Manager can be appointed by the Guardianship Tribunal.
Do you have a signed document for:
General Power of Attorney
Please select...
Yes
No
Appointment Date
If yes to General Power of Attorney, copies of the relevant document must be attached
Enduring Power of Attorney
Please select...
Yes
No
Appointment Date
If yes to Enduring Power of Attorney, copies of the relevant document must be attached
Financial Manager via Guardianship Tribunal
Please select...
Yes
No
Appointment Date
If yes to Financial Manager via Guardianship Tribunal, copies of the relevant document must be attached
Name of Person appointed
Phone
e.g. 0412 345 678 or (02) 9123 6535
Guardian or Enduring Guardian / Advance Care Directive or treatment plan
A person can appoint a Guardian or Enduring Guardian to make decisions in relation to accommodation and medical and other care should that person be unable to do so. Alternatively, a Guardian can be appointed by the Guardianship Tribunal
Do you have a signed document for:
Guardian
Please select...
Yes
No
Appointment Date
If yes to Guardian, copies if the relevant documents must be attached
Enduring Guardian
Please select...
Yes
No
Appointment Date
If yes to Enduring Guardian copies if the relevant documents must be attached
Guardian via Guardianship Tribunal
Please select...
Yes
No
Appointment Date
If yes to Guardian via Guardianship Tribunal copies if the relevant documents must be attached
Restrictive Practices Decision Maker
Please select...
Yes
No
Appointment Date
Name of Person appointed
Phone
e.g. 0412 345 678 or (02) 9123 6535
Do you have a Living Will?
Please select...
Yes
No
Do you have a Advance Care Directive or Treatment Plan?
Please select...
Yes
No
If yes to any of the above, copies of the relevant documents must be attached
By signing this form, you undertake to advise Montefiore of any changes made to any of the above contracts and please send copies of all legal documents with your application
Financial information/income and assets
What best describes your finance?
Please select...
Self-funded retiree
Full aged pension
Part aged pension
Third party
Workers' compensation
Department Veterans Affairs (specify type)
Other (specify)
Dept. of Veterans Affairs (specify type)
Other (please specify)
Pension Number
Expiry Date
Will/executor information
The Executor/s under my Will is/are: (This is for the purpose of refunding the Refundable Accommodation Deposit and other financial arrangements.)
First Name
Last Name
Contact Number
e.g. 0412 345 678 or (02) 9123 6535
Address
Suburb
State
Please select...
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
e.g. 2174
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