This document is an ENDURING POWER OF ATTORNEY that takes effect as soon as it is signed and witnessed. It will continue during your lifetime and it will not come to an end if you become mentally incapacitated in the future,
unless you have revoked it before that time. If you become mentally incapacitated your attorney will have a duty to manage your affairs and will not be able to resign without first obtaining permission from the Supreme Court of
the Northwest Territories.
Text Version of this Form
1
ENDURING POWER OF ATTORNEY
This power of attorney is given on by of
(date) (donor)
.
(donor’s address)
A. EXPLANATORY NOTES FOR THE ASSISTANCE OF THE DONOR
READ THESE NOTES BEFORE SIGNING THIS DOCUMENT
1. This document is an ENDURING POWER OF ATTORNEY that takes effect as soon as it is signed and witnessed.
It will continue during your lifetime and it will not come to an end if you become mentally incapacitated in the future,
unless you have revoked it before that time. If you become mentally incapacitated your attorney will have a duty
to manage your affairs and will not be able to resign without first obtaining permission from the Supreme Court of
the Northwest Territories.
2. You must be nineteen years of age or older to give a power of attorney.
3. The effect of this document is to authorize the person you have named as your attorney to act on your behalf with
respect to your property and financial affairs. This could include your lands, houses, bank accounts, pensions,
RRSPs, stock and mutual fund investments, vehicles and anything else you own.
4. Unless you state otherwise in this document, your attorney will have very wide powers to deal with the types of
property listed above. The attorney will also be able to use your property to provide support for your spouse and
dependant children. You should consider very carefully whether or not you wish to impose any restrictions on the
powers of your attorney.
5. Your attorney should be someone you know and trust completely and who is very capable of handling financial
matters. Your attorney could seriously deplete or eliminate your financial assets.
6. You may not appoint as your attorney a person who is under the age of nineteen years, is mentally incapacitated or
is an undischarged bankrupt.
7. You may revoke this power of attorney at any time, as long as you are mentally capable of understanding what you
are doing.
8. This power of attorney will come to an end on your bankruptcy or death, on the attorney’s bankruptcy, mental
incapacity or death, or on the occurrence of other circumstances as provided in the Powers of Attorney Act.
9. You may name a “recipient” to receive reports on your financial affairs, in the form of an accounting, from your
attorney. The recipient would then be able to review the reports to ensure that your attorney is properly handling
your affairs.
of
(date) (donor)
.
(donor’s address)
A. EXPLANATORY NOTES FOR THE ASSISTANCE OF THE DONOR
READ THESE NOTES BEFORE SIGNING THIS DOCUMENT
1. This document is an ENDURING POWER OF ATTORNEY that takes effect as soon as it is signed and witnessed.
It will continue during your lifetime and it will not come to an end if you become mentally incapacitated in the future,
unless you have revoked it before that time. If you become mentally incapacitated your attorney will have a duty
to manage your affairs and will not be able to resign without first obtaining permission from the Supreme Court of
the Northwest Territories.
2. You must be nineteen years of age or older to give a power of attorney.
3. The effect of this document is to authorize the person you have named as your attorney to act on your behalf with
respect to your property and financial affairs. This could include your lands, houses, bank accounts, pensions,
RRSPs, stock and mutual fund investments, vehicles and anything else you own.
4. Unless you state otherwise in this document, your attorney will have very wide powers to deal with the types of
property listed above. The attorney will also be able to use your property to provide support for your spouse and
dependant children. You should consider very carefully whether or not you wish to impose any restrictions on the
powers of your attorney.
5. Your attorney should be someone you know and trust completely and who is very capable of handling financial
matters. Your attorney could seriously deplete or eliminate your financial assets.
6. You may not appoint as your attorney a person who is under the age of nineteen years, is mentally incapacitated or
is an undischarged bankrupt.
7. You may revoke this power of attorney at any time, as long as you are mentally capable of understanding what you
are doing.
8. This power of attorney will come to an end on your bankruptcy or death, on the attorney’s bankruptcy, mental
incapacity or death, or on the occurrence of other circumstances as provided in the Powers of Attorney Act.
9. You may name a “recipient” to receive reports on your financial affairs, in the form of an accounting, from your
attorney. The recipient would then be able to review the reports to ensure that your attorney is properly handling
your affairs.2
10. Your attorney should sign the acceptance at the end of this document to indicate that he or she agrees to being
appointed as your attorney and that he or she is aware of his or her duties.
11. Neither your attorney, nor his or her spouse, may sign as the witness to your signature on this document.
B. APPOINTMENTS AND DIRECTIONS:
1. (a) I appoint
of to be my attorney
(name) (address)
in accordance with the Powers of Attorney Act and to do on my behalf anything that I can lawfully do by an
attorney.
[OPTIONAL: The donor may name one or more persons to act jointly as attorneys:
(b) In addition to the person I have appointed as my attorney under paragraph (a), I appoint the following person(s)
to act jointly with that person as my attorney(s):
of .]
(name) (address)
[OPTIONAL: The donor may name an alternate attorney:
2. If a person I have appointed as my attorney under paragraph 1(a) or (b) is or becomes unable to act, then I appoint
the following person to act in place of that person:
of .]
(name) (address)
3. In accordance with the Powers of Attorney Act, I declare that this power of attorney is an enduring power of attorney
that shall take effect as soon as it is signed and witnessed, and this power of attorney shall continue in effect during
my lifetime whether or not I become mentally incapacitated in the future, unless revoked by me before that time.
[OPTIONAL: The donor may name a recipient:
4. I name the following person as a recipient who may request reports on my financial affairs from my attorney, and to
whom my attorney must provide an accounting if those reports are requested:
of .]
(name of recipient) (address of recipient)
[OPTIONAL: The donor may state conditions or restrictions regarding the powers given to the attorney:
5. This power o f attorney is subject to the following conditions and restrictions:
to be my attorney
(name) (address)
in accordance with the Powers of Attorney Act and to do on my behalf anything that I can lawfully do by an
attorney.
[OPTIONAL: The donor may name one or more persons to act jointly as attorneys:
(b) In addition to the person I have appointed as my attorney under paragraph (a), I appoint the following person(s)
to act jointly with that person as my attorney(s):
of .]
(name) (address)
[OPTIONAL: The donor may name an alternate attorney:
2. If a person I have appointed as my attorney under paragraph 1(a) or (b) is or becomes unable to act, then I appoint
the following person to act in place of that person:
of .]
(name) (address)
3. In accordance with the Powers of Attorney Act, I declare that this power of attorney is an enduring power of attorney
that shall take effect as soon as it is signed and witnessed, and this power of attorney shall continue in effect during
my lifetime whether or not I become mentally incapacitated in the future, unless revoked by me before that time.
[OPTIONAL: The donor may name a recipient:
4. I name the following person as a recipient who may request reports on my financial affairs from my attorney, and to
whom my attorney must provide an accounting if those reports are requested:
of .]
(name of recipient) (address of recipient)
[OPTIONAL: The donor may state conditions or restrictions regarding the powers given to the attorney:
5. This power o f attorney is subject to the following conditions and restrictions:3
.]
[OPTIONAL: The donor may provide for the attorney(s) to receive compensation:
6. I authorize my attorney(s) to take annual compensation from my property in accordance with the Trustee Fee
Regulations made under the Guardianship and Trustee Act.]
[OPTIONAL: The donor may revoke a previous power of attorney:
7. I revoke the power of attorney previously given by me on ,
(date of power of attorney now being revoked)
appointing .]
(name of attorney appointed in the power of attorney now being revoked)
WITNESSED BY:
(witness must sign here, in presence of donor) (donor must sign here, in presence of witness)
(print name of witness)
(address of witness)
[NOTE: Neither an attorney named in this document, nor the spouse of such an attorney, may witness the donor’s
signature.]
ATTORNEY’S ACCEPTANCE OF APPOINTMENT
I accept the appointment on , 20 .
(date the attorney signs this acceptance)
WITNESSED BY:
(witness must sign here, in presence of attorney) (attorney must sign here, in presence of witness)
(print name of witness)
(address of witness)
[OPTIONAL: The donor may provide for the attorney(s) to receive compensation:
6. I authorize my attorney(s) to take annual compensation from my property in accordance with the Trustee Fee
Regulations made under the Guardianship and Trustee Act.]
[OPTIONAL: The donor may revoke a previous power of attorney:
7. I revoke the power of attorney previously given by me on ,
(date of power of attorney now being revoked)
appointing .]
(name of attorney appointed in the power of attorney now being revoked)
WITNESSED BY:
(witness must sign here, in presence of donor) (donor must sign here, in presence of witness)
(print name of witness)
(address of witness)
[NOTE: Neither an attorney named in this document, nor the spouse of such an attorney, may witness the donor’s
signature.]
ATTORNEY’S ACCEPTANCE OF APPOINTMENT
I accept the appointment on , 20 .
(date the attorney signs this acceptance)
WITNESSED BY:
(witness must sign here, in presence of attorney) (attorney must sign here, in presence of witness)
(print name of witness)
(address of witness)