The form was created by the Department of Justice & Community Safety.

It allows you to appoint one attorney and up to two alternative attorneys.

If you want to appoint more attorneys or alternative attorneys, use the long version.

Download and save the form before filling it out.

Once completed, print it out. It needs to be signed in front of the required witnesses.

Having trouble using this form?

Please see OPA's guide to fixing problems you may experience wen completing forms that can be filled electronically.

Support for using powers of attorney forms that can be filled electronically >