Enduring Guardianship
in New South Wales
APPOINTMENT OF ENDURING GUARDIAN FORM
Revised March 2018
Appointment of Enduring Guardian
For New South Wales
(Guardianship Regulation 2016, Schedule 1)
Important information to read before completing the
Enduring Guardianship appointment form
• AnEnduringGuardianshipappointmentisanimportantdocument.Itallows
someoneelsetomakemedicalandlifestyledecisionsonyourbehalf.Youshould
getlegalormedicaladvice(orboth)beforeyousignit.
• ItisimportantthatyoutrustthepersonyouappointasyourEnduringGuardian
tomakeappropriatelifestyledecisionsonyourbehalf.Itisrecommendedyou
informthispersonofyourwishesaboutlifestyledecisionsandinvolvethemin
discussionsaboutyourviewsorgoals.Ifthesechange,itisimportanttoletyour
EnduringGuardianknow.
• AnEnduringGuardiancanonlymakelifestyledecisionssuchashealthdecisions.
YoushouldmakeanEnduringPowerofAttorneyifyouwantsomeonetomake
nancialdecisionsonyourbehalfifyoulosecapacity.
• IfyouappointmorethanoneEnduringGuardian,youshouldindicatewhetherthe
EnduringGuardiansaretoactjointly,severallyorjointlyandseverally.Enduring
Guardianswhoareappointedjointlyareonlyabletomakedecisionsiftheyall
agreeaboutthedecision.EnduringGuardianswhoareappointedseverallyor
jointlyandseverallyareabletomakedecisionsindependentlyofeachother.
• IfyouappointasubstituteEnduringGuardian*,theywillonlyhaveauthorityto
actasyourguardianiftherstappointedenduringguardian/sdies,resignsor
becomesincapacitated.
• EachEnduringGuardianmustsigntheiracceptanceontheappointmentforitto
beeffective.
• Ifsomeonesignstheappointmentonyourbehalf,theymustbeatleast18years
old.TheymustnotbethepersonbeingappointedasanEnduringGuardian.
Theycannotalsowitnesstheexecutionoftheappointment.
• IfyoumarryafteryouappointanEnduringGuardianthentheappointmentwill
automaticallyberevoked(unlessyoumarriedyourEnduringGuardian).
•
YourEnduringGuardiancanresignatanytime,bygivingyounoticeinwriting.Ifyou
havelostcapacitytomakedecisionsatthattimethenyourEnduringGuardiancan
onlyresignwiththeapprovaloftheNSWCivil&AdministrativeTribunal.
•
EnduringGuardianshipappointmentsarenotautomaticallyaccessibleonanypublic
register.Therefore,itisimportantthatkeypeopleareawareoftheappointmentso
theycancontacttheEnduringGuardianifrequired.Youshouldprovideacopyof
theEnduringGuardianshipappointmenttoyourEnduringGuardianandkeepacopy
inasafeplace.Youshouldalsoletclosefriendsorfamilyknowaboutitandgivea
copytoyoursolicitor,doctorandhealthserviceprovider.
• Furtherinformation:
TheOfceofthePublicGuardiancanprovideinformationonguardianship,
call 02 8688 6070.
NSWTrustee&GuardiancanprepareandwitnessyourEnduringGuardianship,
call 1300 364 103.
NSWCivil&AdministrativeTribunalGuardianshipDivisionshouldbecontacted
ifapersondoesnothavelegalcapacityorthereareconcernsaboutwhether
someonehadcapacitywhenanEnduringGuardianshiporPowerofAttorney
wasprepared,call1300 006 228.
*previouslyreferredtoasalternateguardian
EnduringGuardianshipAppointmentFormNewSouthWales Page1of11
Appointment of Enduring Guardian
For New South Wales
(Guardianship Regulation 2016, Schedule 1)
1. Appointment of Enduring Guardian/s
I, [your full name]: __________________________________________________
Of [your address]: __________________________________________________
__________________________________________________________________
Occupation: _______________________________________________________
Phonenumber: ____________________________________________________
Dateofbirth: ______________________________________________________
Appoint [guardians name]: __________________________________________
Of[guardians address]: _____________________________________________
__________________________________________________________________
Phone number: ____________________________________________________
Occupation: _______________________________________________________
Appoint [guardians name]: __________________________________________
Of[guardians address]: _____________________________________________
__________________________________________________________________
Phonenumber: ____________________________________________________
Occupation: _______________________________________________________
Appoint [guardians name]: __________________________________________
Of[guardians address]: _____________________________________________
__________________________________________________________________
Phonenumber: ____________________________________________________
Occupation: _______________________________________________________
to be my Enduring Guardian/s.
2. Optional – substitute guardian
I appoint [substitute Enduring Guardians name]: ________________________
__________________________________________________________________
Of[address]: _______________________________________________________
__________________________________________________________________
Phonenumber: ____________________________________________________
Occupation: _______________________________________________________
to be my substitute Enduring Guardian.
Completeyourdetails
inthespaceprovided.
Appointor – Theperson
whomakesanEnduring
Guardianappointmentis
knownastheappointor.
Enduring Guardians –
Youmayappointoneor
morepeopletobeyour
EnduringGuardian/s.
Ifyouareappointingmore
thanoneEnduringGuardian
completedetailsforeach
guardian.
Note:anEnduring
Guardianmustbe18years
ofageandnothaveany
connectionwiththose
whoprovideyouwith
accommodation,health
careorservicesforafee.
Completethissectionifyou
wishtoappointasubstitute
guardian.
Asubstituteguardianis
someoneyouappointtobe
yourEnduringGuardianif
yourEnduringGuardian/s
dies,resignsorbecomes
incapacitated.
Note:Crossoutthissection
ifyoudonotwishtoappoint
asubstituteguardian.
EnduringGuardianshipAppointmentFormNewSouthWales Page2of11
3. How I wish my Enduring Guardians to act
[Complete only if more than one Enduring Guardian has been appointed]
Ticktheapplicableboxbelowtoindicatewhetheryouareappointingyour
EnduringGuardianstoactjointly,severallyorjointlyandseverally.
Alsoindicatebytickingtheappropriateboxwhetheryouwantyourjointly/
jointlyandseverallyappointedEnduringGuardian/stocontinueintheirrole
intheeventofdeath,resignationorlossofcapacity.
3a) Joint appointment
IappointmyEnduringGuardianstoactjointlyand
[tick applicable box below]
IwanttheappointmenttobeterminatedifoneofmyEnduring
Guardiansdies,resignsorlosescapacity.
OR
Idonotwanttheappointmenttobeterminatedifoneofmy
EnduringGuardiansdies,resignsorlosescapacity.
3b) Several appointment
IappointmyEnduringGuardianstoactseverally.
3c) Joint and several appointment
IappointmyEnduringGuardianstoactjointlyandseverallyand
[tick applicable box below]
Iwanttheappointmenttobeterminatedifoneofmy
EnduringGuardiansdies,resignsorlosescapacity.
OR
Idonotwanttheappointmenttobeterminatedifoneof
myEnduringGuardiansdies,resignsorlosescapacity.
Tickapplicablebox/es
toindicatehowyouwish
yourEnduringGuardians
tomakedecisionsonyour
behalf.
Jointly
ThismeanstheEnduring
Guardiansmustagreeand
makealldecisionstogether.
Ifyouhaveappointedyour
EnduringGuardiansto
actjointlyyourEnduring
Guardianshipappointment
willautomaticallyterminate
ifoneofyourEnduring
Guardians dies, resigns or
becomesincapacitated.
Ifyoudonotwantthe
appointmenttoterminate
butwanttheremaining
EnduringGuardian/sto
continue in their role then
ticktheappropriatebox.
Severally
ThismeanstheEnduring
Guardianscanmake
decisionsseparately
ofeachother.
Ifyouhaveappointedyour
EnduringGuardianstoact
severallyyourEnduring
Guardianshipappointment
willautomaticallycontinue
ifoneofyourEnduring
Guardians dies, resigns or
becomesincapacitated.
Jointly and severally
ThismeanstheEnduring
Guardianscaneithermake
decisions together or
separately.
Ifyouhaveappointedyour
EnduringGuardianstoact
jointlyandseverallyyour
EnduringGuardianship
appointmentwill
automaticallycontinue
ifoneofyourEnduring
Guardians dies, resigns
orbecomesincapacitated.
Ifyoudonotwantthe
appointmenttocontinue
butwantittoterminatethen
ticktheappropriatebox.
EnduringGuardianshipAppointmentFormNewSouthWales Page3of11
4. Functions and limits of my Enduring Guardian/s
ShouldIbecomeincapableofmakingmyownpersonaldecisionsI
authorisemyEnduringGuardian/stoexercisethefollowingfunctions:
[tick any one or more boxes below]
todecidewhereIlive
LimitsonauthorityofEnduringGuardian: ______________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
todecidewhathealthcareIreceive
LimitsonauthorityofEnduringGuardian: ______________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
todecidewhatotherkindsofpersonalservicesIreceive
LimitsonauthorityofEnduringGuardian: ______________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
toconsenttothecarryingoutofmedicalordentaltreatmentonme
(in accordance with Part 5 of the Guardianship Act 1987)
LimitsonauthorityofEnduringGuardian: ______________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
todecide:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
EnduringGuardian/scan
onlymakehealthand
lifestyledecisions.You
shouldmakeanEnduring
PowerofAttorneyifyou
wantsomeonetomake
nancialdecisionsonyour
behalf.
Selectwhatfunctions
youwishyourEnduring
Guardian/stohaveshould
youlosecapacitytomake
decisionsyourself.
Youmayplacelimits
onthesefunctions.
Ifyouwishtoplacea
limitonthefunctionprovide
detailsinthespacebelow
eachfunction.
Note:
YourEnduringGuardian/s
canonlyexercisethese
functionsifyouhavelost
thecapacitytomake
decisionsyourself.
Youmayaddanyadditional
functionsyouwishyour
EnduringGuardian/sto
exerciseonyourbehalf.
Forexampleotherfunctions
couldinclude:
• access(makingdecisions
aboutwhoyoushould
havecontactwith).
• restrictivepractices
(decidingwhetherto
consenttotheuseof
physicalrestraintfora
limitedperiodtoprotect
youfromselfharm).
EnduringGuardianshipAppointmentFormNewSouthWales Page4of11
5. Optional – directions to my Enduring Guardian/s
ThefunctionsofmyEnduringGuardian/smustbeexercisedinaccordance
withthefollowingdirections:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
YoumaygiveyourEnduring
Guardian/sdirectionsabout
howyouwantthemtocarry
outtheirfunctions.
Forexample,youcandirect
themtoconsultotherfamily
membersbeforemaking
adecisionorgivedetails
aboutthekindofplaceyou
wouldliketoliveifyoulost
capacity.
Note:AnEnduring
Guardianmustexercise
theirfunctionsaccording
toanydirectionsyougive
them.
Youcanonlygivelawful
directions.Youcannotgive
directionstoyourEnduring
Guardian/stodosomething
whichisagainstthelaw.
Youmaywishtodirect
yourEnduringGuardianto
refertoyourAdvanceCare
Directivewhenmaking
medicalandhealthcare
decisions.
EnduringGuardianshipAppointmentFormNewSouthWales Page5of11
6. Appointor’s signature and witness certificate
(Option – for Enduring Guardian signature/witness)
6a) My signature
Signature ___________________________ Date ________________________
6b) Optional – signature on my behalf
Theappointorinstructedmetosignthisappointmentontheirbehalf.
Signatureonbehalfofappointor _____________________________________
Date _____________________________________________________________
Signer’sfullname __________________________________________________
Signer’s address ___________________________________________________
Signer’sphonenumber: ____________________________________________
6c) Acceptance by Enduring Guardian
[Complete only if witnessed at the same time and by the same witness as
appointor. Cross out if this does not apply]
IacceptmyappointmentasEnduringGuardian.
Fullname _________________________________________________________
Signature ___________________________ Date ________________________
6d) My witness certicate
I, [your full name]: __________________________________________________
Of[your address]: __________________________________________________
Phonenumber: ____________________________________________________
Occupation:
Australianlegalpractitioner
RegistraroftheNSWLocalCourt
Overseas-registeredforeignlawyer
ApprovedemployeeofNSWTrustee&Guardian
Certify that [Tick applicable boxes below, cross out those which do not apply]
Theappointorappearedtounderstandtheeffectofthisinstrument
andvoluntarilyexecutedtheinstrumentinmypresence.
Theappointorvoluntarilyinstructed[insert signer’s full name]
_____________________________________________________________
tosigntheinstrumentontheirbehalfandthatpersonexecutedthe
instrumentinmypresence.
_____________________________________________________________
[insert name of person accepting appointment as Enduring Guardian]
appearedtounderstandtheeffectofthisinstrumentandvoluntarily
executedtheinstrumentinmypresence.
Signature ___________________________ Date ________________________
You and your Enduring
Guardian can sign
this page at the same
time, in front of the
samewitness.
If your Enduring
Guardian’s signature
is witnessed at a
different time or by a
different witness, they
will need a separate
witness certicate.
Complete additional
signature and witness
certicate pages.
Note:
Beforeyousignhere
youmustarrangefora
witnesstowatchyou
signthisappointment
andcertifythatyou
appear to understand this
appointment.Yourwitness
needstocompletetheir
detailsinsection6d)below.
Ifyouarephysicallyunable
tosignasktheperson
signingforyoutosign
andcompletetheirdetails
opposite.Thepersonmust
beover18yearsandmust
notbethepersonbeing
appointedorthewitnessas
describedbelow.
Thewitnesscannotbe
theEnduringGuardian,
orasubstituteEnduring
Guardian.
Thewitnessmustbean
Australianlegalpractitioner/
RegistraroftheNSW
LocalCourt/overseas-
registeredforeignlawyer
orapprovedemployeeof
NSWTrustee&Guardian.
Onlythesepersonscan
witnesstheexecutionof
thisappointment.
EachEnduringGuardian
mustsigntheiracceptance
ontheappointmentforitto
beeffective.
IMPORTANT Refer to checklist before completing this section
EnduringGuardianshipAppointmentFormNewSouthWales Page6of11
7.  Optional – substitute Enduring Guardian’s
acceptance and witness certicate
7a) Acceptance by substitute Enduring Guardian
[Complete only if substitute Enduring Guardian appointed]
IacceptmyappointmentasEnduringGuardian.
Fullname _________________________________________________________
Signature ___________________________ Date ________________________
7b) Substitute Enduring Guardian’s witness certicate
I, [full name]: _______________________________________________________
Of[address]: _______________________________________________________
__________________________________________________________________
Phonenumber: ____________________________________________________
Occupation:
Australianlegalpractitioner
RegistraroftheNSWLocalCourt
Overseas-registeredforeignlawyer
ApprovedemployeeofNSWTrustee&Guardian
Certify that _______________________________________________________
[insert name of person accepting appointment as substitute Enduring
Guardian]
appearedtounderstandtheeffectofthisinstrumentandvoluntarily
executedtheinstrumentinmypresence.
Signature ___________________________ Date ________________________
Note:
Beforethesubstitute
EnduringGuardiansigns
heretheymustarrangefor
awitnesstowatchthem
signthisform.Thewitness
needstocompletetheir
detailsinsection7b)below.
Thewitnesscannotbe
theEnduringGuardian,
orasubstituteEnduring
Guardian/s.
Thewitnessmustbean
Australianlegalpractitioner/
RegistraroftheNSW
LocalCourt/overseas-
registeredforeignlawyer
orapprovedemployeeof
NSWTrustee&Guardian.
Onlythesepersonscan
witnesstheexecutionof
thisappointment.
EnduringGuardianshipAppointmentFormNewSouthWales Page7of11
8.  Enduring Guardian’s acceptance and witness
certicate
8a) Acceptance by Enduring Guardian
[Cross out if Enduring Guardian has already signed and Enduring Guardians
witness certicate has been completed]
IacceptmyappointmentasEnduringGuardian.
Fullname _________________________________________________________
Signature ___________________________ Date ________________________
8b) Enduring Guardian’s witness certicate
I, [full name]: ________________________________________________________
Of[address]: ________________________________________________________
___________________________________________________________________
Phonenumber: _____________________________________________________
Occupation:
Australianlegalpractitioner
RegistraroftheNSWLocalCourt
Overseas-registeredforeignlawyer
ApprovedemployeeofNSWTrustee&Guardian
Certify that _______________________________________________________
[insert name of person accepting appointment as Enduring Guardian]
appearedtounderstandtheeffectofthisinstrumentandvoluntarily
executedtheinstrumentinmypresence.
Signature ___________________________ Date ________________________
Note:
BeforetheEnduring
Guardiansignsherethey
mustarrangeforawitness
towatchthemsignthis
form.Thewitnessneeds
tocompletetheirdetails
insection8b)below.
Thewitnesscannotbe
theEnduringGuardian,
orasubstituteEnduring
Guardian/s.
Thewitnessmustbean
Australianlegalpractitioner/
RegistraroftheNSW
LocalCourt/overseas-
registeredforeignlawyer
orapprovedemployeeof
NSWTrustee&Guardian.
Onlythesepersonscan
witnesstheexecutionof
thisappointment.
YourEnduringGuardian/s
canresignatanytime
bygivingyounoticein
writing.Ifyouhavelost
capacityatthattime,then
yourEnduringGuardian/s
canonlyresignwiththe
approvaloftheNSWCivil&
AdministrativeTribunal.
EnduringGuardianshipAppointmentFormNewSouthWales Page8of11
9.  Additional Enduring Guardian’s signature and
witness certificate/s
[Cross out if Enduring Guardian has already signed and Enduring Guardians
witness certicate has been completed]
9a) Acceptance by Enduring Guardian
IacceptmyappointmentasEnduringGuardian.
Fullname _________________________________________________________
Signature ___________________________ Date ________________________
9b) Enduring Guardian’s witness certicate
[Cross out if Enduring Guardians signature already witnessed]
I, [full name]: _______________________________________________________
Of [address]: _______________________________________________________
__________________________________________________________________
Phonenumber: ____________________________________________________
Occupation:
Australianlegalpractitioner
RegistraroftheNSWLocalCourt
Overseas-registeredforeignlawyer
ApprovedemployeeofNSWTrustee&Guardian
Certify that _______________________________________________________
[insert name of person accepting appointment as Enduring Guardian]
appearedtounderstandtheeffectofthisinstrumentandvoluntarily
executedtheinstrumentinmypresence.
Signature ___________________________ Date ________________________
Note:
Beforeyousignhereyou
mustarrangeforawitness
towatchyousignthis
form.Thewitnessneeds
tocompletetheirdetailsin
section9b)below.
Thewitnessescannot
betheEnduringGuardian,
orasubstituteEnduring
Guardian/s.
Thewitnessmustbean
Australianlegalpractitioner/
RegistraroftheNSW
LocalCourt/overseas-
registeredforeignlawyer
orapprovedemployeeof
NSWTrustee&Guardian.
Onlythesepersonscan
witnesstheexecutionof
thisappointment.
EnduringGuardianshipAppointmentFormNewSouthWales Page9of11
9aa) Acceptance by Enduring Guardian
[Cross out if Enduring Guardian has already signed and Enduring Guardians
witness certicate has been completed]
IacceptmyappointmentasEnduringGuardian.
Fullname _________________________________________________________
Signature ___________________________ Date ________________________
9bb) Additional Enduring Guardian’s witness certicate
[Cross out if Enduring Guardians signature already witnessed]
I, [full name]: _______________________________________________________
Of[address]: _______________________________________________________
__________________________________________________________________
Phonenumber: ____________________________________________________
Occupation:
Australianlegalpractitioner
RegistraroftheNSWLocalCourt
Overseas-registeredforeignlawyer
ApprovedemployeeofNSWTrustee&Guardian
Certify that _______________________________________________________
[insert name of person accepting appointment as Enduring Guardian]
appearedtounderstandtheeffectofthisinstrumentandvoluntarily
executedtheinstrumentinmypresence.
Signature ___________________________ Date ________________________
Note:
Beforeyousignhereyou
mustarrangeforawitness
towatchyousignthis
form.Thewitnessneeds
tocompletetheirdetailsin
section9bb)below.
Thewitnessescannot
betheEnduringGuardian,
orasubstituteEnduring
Guardian/s.
Thewitnessmustbean
Australianlegalpractitioner/
RegistraroftheNSW
LocalCourt/overseas-
registeredforeignlawyer
orapprovedemployeeof
NSWTrustee&Guardian.
Onlythesepersonscan
witnesstheexecutionof
thisappointment.
EnduringGuardianshipAppointmentFormNewSouthWales Page10of11
Enduring Guardianship Checklist
CheCklist
Please read below and tick to ensure you have completed all details of your Enduring
Guardianshipappointment correctly.
1. IhavespokentomyproposedEnduringGuardian/sanddiscussedthis
appointmentwiththemtoensuretheyarewillingandabletotakeonthisrole
andexercisethefunctionsIwishtogivethemasdescribedinsections3and4.
2. ItrustmyEnduringGuardian/sandhavespokentothemaboutthekindof
lifestyledecisionsIwishthemtomakeonmybehalfshouldIlosecapacity.
Ifthesechange,IunderstanditisimportanttoletmyEnduringGuardian/sknow.
3. IhavediscussedtheappointmentofmyEnduringGuardian/swithmyclose
friends/familytoletthemknowofmydecisiontoappointanEnduringGuardian.
4. Ihaveconsideredtheoptioninsection2ofappointingasubstituteguardian
shouldmyrstappointedEnduringGuardiandie,resignorbecome
incapacitated.
5. IhaveindicatedhowIwishmyEnduringGuardianstoact(i.e.jointly,severallyor
jointlyandseverally)bycompletingsection3.
6. IunderstandIcanasksomeonetosignthisappointmentonmybehalfin
section6ifIamphysicallyunabletosign.Thispersonmustbeovertheageof
18andcannotbemyEnduringGuardian/sorawitnesstothisappointment.
7. Iunderstandthecerticateofwitnessneedstobecompletedbyaneligible
witness,i.e.anAustralianlegalpractitioner/RegistraroftheNSWLocalCourt/
overseas-registeredforeignlawyerorapprovedemployeeofNSWTrustee
&Guardian.
8. IunderstandmyEnduringGuardian/sneedtosigntheiracceptanceofthe
EnduringGuardianappointmentbeforeitcanoperate.
9. IunderstanditisimportanttogiveacopyofthisEnduringGuardianship
appointmenttomyEnduringGuardian/sandotherrelevantpeople,suchas
myGPandattorney,andIwillkeepacopyinasafeplace.Thereisnopublic
registerforEnduringGuardianshipappointments.
10.IunderstandthatifImarry,theEnduringGuardianshipappointmentwillbe
revokedunlessIammarryingmyEnduringGuardian.
11.Iunderstanditisadvisabletogetmedicalandlegaladvicebeforesigning
myEnduringGuardianshipappointment.
EnduringGuardianshipAppointmentFormNewSouthWales Page11of11
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