Victorian Numbered Regulations

POWERS OF ATTORNEY AMENDMENT REGULATIONS 2017 (SR NO 17 OF 2017) - REG 9

For Form 6 in Schedule 1 to the Principal Regulations substitute —

" FORM 6

REVOCATION BY PRINCIPAL OF SUPPORTIVE ATTORNEY APPOINTMENT OR APPOINTMENT OF SUPPORTIVE ATTORNEY/ALTERNATIVE SUPPORTIVE ATTORNEY

Regulation 10

Name of principal:

Address of principal:

I revoke under section 103 of the Powers of Attorney Act 2014 :

*the supportive attorney appointment made by me on [ insert date made ].

*the appointment of my supportive attorney(s) [ insert name of supportive attorney or attorneys if revoking the appointment of more than one ] of [ insert address(es) of supportive attorney(s) ] under the supportive attorney appointment made by me on [ insert date made ].

*the appointment of my alternative supportive attorney(s) [ insert name of alternative supportive attorney or attorneys if revoking the appointment of more than one ] of [ insert address(es) of alternative supportive attorney(s) ] for [ insert name of supportive attorney(s) ] under the supportive attorney appointment made by me on [ insert date made ].

Signed : [ signature of principal or person signing at the direction of (on behalf of) the principal ]

*I sign this instrument of revocation at the direction of and in the presence of the principal.

*Name of person signing at direction of principal:

*Address of person signing at direction of principal:

Date:

Witnessed by: [ signature of witness ]

Name of witness:

Address of witness:

Qualification: [ specify how authorised to witness the signing of a statutory declaration ]

Date:

*Delete if not applicable.".