Fillable Gd Form Guardianship Application Guardianship Application

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Gd Form Guardianship Application Guardianship Application

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  • 15 check-boxes
  • 119 other fields

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NCAT Guardianship Division Form | Guardianship application Page | 1
Feb 2020
Guardianship application
GUARDIANSHIP DIVISION
Complete this form to apply to NCAT to appoint a guardian under the Guardianship Act 1987. Guardians can make
decisions about a person's health, accommodation, services or other lifestyle matters. The person the application is
about must be over 16 years, usually lives in NSW, and has a decision making disability.
If decisions need to be made about financial matters, consider applying to NCAT for a financial management order.
Refer to the ‘Financial management application’ form for further details.
IMPORTANT INFORMATION:
When lodging a guardianship application with NCAT you must also send a copy of the application and any attachments to all
parties including the Public Guardian.
File Number
Office use only
1. PERSON THIS APPLICATION IS ABOUT
A. PERSON’S NAME AND ADDRESS
Given names Family name
Date of birth Gender
Addr
ess
Co
ntact details Daytime telephone Mobi
le
Email
B. IS THIS THE PERSON’S CURRENT LOCATION? YES NO (provide current location below)
Address
Contact details Daytime telephone Mobi
le
Email
C. WHAT TYPE OF ACCOMMODATION ARE THEY CURRENTLY IN?
Own home Hospital Care facility or supported accommodation
Home of friend or family member No fixed place of address Other
D. WHAT IS THE PERSON’S VIEW ABOUT THIS APPLICATION?
Have you told the person you are making this application? You should tell the person that you are making an
application about them. Have you done this?
YES NO (why not?)
Do they agree with the application being made? YES NO DON’T KNOW
NCAT Guardianship Division Form | Guardianship application Page | 2
E. WHY DO YOU THINK THE PERSON HAS A DECISION MAKING DISABILITY?
Dementia Advanced Age Intellectual Disability Neurological Brain Injury
Other (please specify)
Do you have any written evidence about the person’s disability and their capacity to manage their financial affairs?
For example, a report from a doctor or other health care professional. If yes, please attach.
YES NO (why not?)
Is the person the subject of a corresponding order made in another Australian state, territory or New Zealand?
NO YES (provide details)
Has the person been the subject of a previous application or order at NCAT (or former NSW Guardianship Tribunal)?
If yes, please provide the client number
NO YES (provide details)
Are you making this application because of the National Disability Insurance Scheme (NDIS)?
YES NO
F. ASSISTANCE AT THE HEARING
Can the person attend the hearing in perso
n?
YES NO (why not?)
If the person cannot attend the hearing in person, can they participate by telephone or videoconference?
YES NO (why not?)
Does the person need special assistance to participate in the hearing? For example, hearing loop or wheelchair access.
NO YES (provide details)
Does the person use any form of Alternative and Augmentative Communication? (AAC) For example communication
device, communication board or book, Key Word Sign
NO YES (please specify)
Does the person identify as belonging to a specific ethnic, cultural or religious group?
NO YES (please specify)
Does the person need an interpreter?
NO YES (which language)
NCAT Guardianship Division Form | Guardianship application Page | 3
2. APPLICANT
Are you making this application about yourself? YES NO (provide your details below)
Given names Family name
Relationship to person
P
ostal address
C
ontact details Daytime telephone M
obile
Email
I agree to have NCAT notices and correspondence sent to my email address
By ticking this box you agree to receive the notice of hearing and other correspondence by email. Please provide an email
address that is accurate and checked regularly.
I have read the Information for Applicants fact sheet
By ticking this box you agree that you understand your responsibilities as an applicant and are willing to continue in that role.
3. PUBLIC GUARDIAN
A. HAVE YOU SENT A COPY OF THIS APPLICATION TO THE PUBLIC GUARDIAN? NO YES
NSW Public Guardian is a statutory party to all NCAT Guardianship Applications.
You must send a copy of your completed application and any attachments to the Public Guardian at one of the following
addresses.
Please indicate which method you will use to send your completed application to the Public Guardian.
Post: Locked Bag 5116, Parramatta NSW 2124
Fax: 02 8688 9797
Email: PGERegistry@opg.nsw.gov.au
4. OTHER PARTIES
A. DOES THE PERSON HAVE A SPOUSE? NO YES (PROVIDE DETAILS)
Given names Family name
Postal Address
C
ontact details Daytime telephone M
obile
Email
B. DOES THE PERSON HAVE A CARER? NO YES (PROVIDE DETAILS)
Given names Family name
Postal Address
C
ontact details Daytime telephone M
obile
Email
NCAT Guardianship Division Form | Guardianship application Page | 4
C. HAS THE PERSON APPOINTED AN ENDURING GUARDIAN? NO YES (PROVIDE DETAILS)
If there is an enduring guardianship appointment, please attach a copy (or copies if more than one exists)
Given names
Family name
Postal Address
Contact details Daytime telephone
Mobile
Email
D. AC
KNOWLEDGEMENT OF PARTIES
A ‘party’ is someone who has certain rights in the Tribunal proceedings, such as the right to receive a copy of the
application and notice of hearing. All of the above people (including the person the application is about) are parties to the
proceedings.
I understand and acknowledge that I will provide a copy of my completed application and any attachments to:
Public Guardian
Post: Locked Bag 5116, Parramatta NSW 2124
Fax: 02 8688 9797
Email: PGERegistry@opg.nsw.gov.au
The person the application is about
Their spouse (if any)
Their carer (if any)
Their appointed Enduring Guardian (if any)
5. OTHER PEOPLE IN THE PERSON’S LIFE
Are there any other people in the person’s life (social workers, doctors, family or friends) that could help NCAT
make its decision? If yes, provide their full name, contact details and their relationship to the person this application is
about.
You must include anyone who may disagree with the application. Other people may not be parties but may apply to the
Tribunal to be joined if they have sufficient interest.
NCAT Guardianship Division Form | Guardianship application Page | 5
6. NEED FOR A GUARDIAN
NCAT can only appoint a guardian for a person who has a disability that affects their decision making capability if:
· there is a current need for someone else to make personal decisions for them
· decisions cannot be made informally, and
· it is in the person’s best interests for an order to be made.
A. WHY ARE YOU ASKING FOR A GUARDIAN TO BE APPOINTED?
Explain why you think a guardian should be appointed, including any attempts made to informally resolve issues.
B. D
O YOU BELIEVE THIS MATTER IS URGENT BECAUSE THE PERSON IS AT RISK?
NO
YES Provide details.
C. WH
O DO YOU SUGGEST FOR THE ROLE OF GUARDIAN?
The proposed guardian must be aware of this application unless you are proposing the Public Guardian.
Yourself Public Guardian Don’t know
Someone else (provide details below)
Given names Family name
Relationship to person
P
ostal address
C
ontact details Daytime telephone M
obile
Email
NCAT Guardianship Division Form | Guardianship application Page | 6
7. APPLICATION CHECKLIST
I have attached all other documents relevant to this application
Include medical evidence or reports and written statements only if they are relevant to the issues NCAT needs to decide.
Attach a copy of the Enduring Guardian Appointment if applicable.
I have sent a copy of this application and attachments to NCAT
To lodge your application, return all pages of the form to NCAT’s Guardianship Division. Check that you have completed
all relevant items and signed the application form.
NCAT Guardianship Division
Post: PO Box K1026, Haymarket NSW 1240
In person: Level 6 John Maddison Tower, 86-90 Goulburn Street, Sydney
Email: gd@ncat.nsw.gov.au
I have sent a copy of this application and attachments to the Public Guardian
The Public Guardian is a statutory party to all NCAT Guardianship Applications. You must send copies of all documents,
including this application and any attachments, to the Public Guardian at one of the following addresses.
Public Guardian
Post: Locked Bag 5116, Parramatta NSW 2124
Fax: 02 8688 9797
Email: PGERegistry@opg.nsw.gov.au
I have sent a copy of this application and attachments to all other parties
You must send copies of all documents, including this application and any attachments, to all other parties to the
application including the person who the application is about.
I have made a copy of this application for my own records
Before lodging your application with NCAT you must make a copy of your application for your own records.
8. DECLARATION AND SIGNATURE
Declaration Having read through this completed application:
I consider that, to the best of my knowledge, all of the information is true and accurate.
I have not intentionally left out important information or the names of people who are likely to have a
legitimate interest in the application.
I understand that it is an offence to make a false or misleading statement in an application.
Name
Signature Dat
e
NCAT GUARDIANSHIP DIVISION
Postal address: PO Box K1026, Haymarket NSW 1240
DX 11539 Sydney Downtown
Street address: Level 6 John Maddison Tower, 86-90 Goulburn Street, Sydney
Telephone: (02) 9556 7600 or 1300 006 228
Interpreter Service (TIS) 13 14 50
National Relay Service 1300 555 727
Email: gd@ncat.nsw.gov.au
Website: www.ncat.nsw.gov.au
click to sign
signature
click to edit
NCAT Guardianship Division Form | Guardianship application Page | 7
GUIDE TO COMPLETING THE APPLICATION FORM
Use the following information to help you complete the NCAT Guardianship Division Guardianship Application Form. Section
headings and numbers match the questions on the form.
1. PERSON THE APPLICATION IS ABOUT
A. PERSON’S NAME AND ADDRESS
Provide the person’s full name and usual address.
B. PERSON’S CURRENT LOCATION
This is the address of the place where the person is staying
if they are not at their usual address.
C. WHAT TYPE OF ACCOMMODATION ARE THEY
CURRENTLY IN?
Tick the box that best describes where the person is
currently living.
D. WHAT IS THE PERSON’S VIEW ABOUT THIS
APPLICATION?
You must tell the person you are making an application
about them and ask whether they agree to it. NCAT may
still make an order if they don't agree, but must take their
views into account.
E. WHY DO YOU THINK THE PERSON HAS
A
DECISION MAKING DISABILITY?
The person must have a disability that affects their decisio
n
m
aking. There must also be a current need for someon
e
el
se to make decisions about the person's health,
accommodation or services. This may or may not be due t
o
a medical condition. Attach any evidence you have about
the person's condition or their ability to make their ow
n
d
ecisions.
F. ASSISTANCE AT THE HEARING
NCAT prefers that the person attends the hearing in
person. If they are not able to attend in person, a video or
teleconference can be arranged. If other assistance is
required, or the person cannot take part in the hearing, you
should contact NCAT.
2. APPLICANT
The applicant is the person who is lodging the application.
Provide your details here unless you are the person the
applicant is about.
I agree to have NCAT notices and correspondence sent
to my email address
By ticking this box you agree to receive all correspondence
by email.
I have read the ‘Information for Applicants’ fact sheet
You must have read and understood the responsibilities of
an applicant before you continue. If at any stage you are
unwilling or unable to continue in the role you should find
someone else to take over and inform NCAT.
3. PUBLIC GUARDIAN
A. HAVE YOU SENT A COPY OF THIS APPLICATION
TO THE PUBLIC GUARDIAN?
The Public Guardian is a statutory party to all NCAT
Guardianship Applications. You must send a copy of your
application and any attachments to the Public Guardian.
The Public Guardian is a separate organisation from
NCAT.
4. OTHER PARTIES
A. DOES THE PERSON HAVE A SPOUSE?
A spouse is the husband, wife or de facto partner
(including same sex partner) of the person the application
is about. The spouse must have a close and continuing
relationship with the person.
B. DOES THE PERSON HAVE A CARER?
A carer is an unpaid person who provides or arranges for
domestic services and support for the person on a regular
basis, or before the person lived in a residential care
facility. The carer is still considered unpaid if they receive a
carer’s pension.
C. HAS THE PERSON APPOINTED AN ENDURING
GUARDIAN?
An enduring guardian is someone appointed by the
person to make lifestyle, health and medical decisions for
when they are not capable of doing this for themselves.
If applicable, please attach of copy of the person’s signed
Appointment of Enduring Guardian Form.
D. ACKNOWLEDGEMENT OF PARTIES
All material sent to NCAT must also be sent to the Public
Guardian and all other parties, including the person that the
application is about, unless NCAT makes an order to
restrict disclosure about the proceedings (section 64 Civil
and
Administrative Tribunal Act 2013). You must provide
good reasons if you want orders made to restrict
disclosure.
5. OTHER PEOPLE IN THE PERSON’S LIFE
If the person has close friends or relatives that have
frequent contact with the person, and an interest in their
welfare, they should be listed. Professionals such as social
workers or doctors should also be listed.
6. NEED FOR A GUARDIAN
A. WHY ARE YOU ASKING FOR A GUARDIAN TO BE
APPOINTED?
Most adults with disabilities are assisted with decisio
n
m
aking by family members, friends or service providers.
These informal decision making arrangements often meets
the person’s needs. NCAT must be satisfied that:
· the person the application is about has a decisi
on
m
aking disability
· the disability results in the person being partially or
wholly incapable of managing themselves, and
· t
here is a need for the person to have a guardia
n
appoi
nted.
If the person already has informal decision making or an
enduring guardianship appointment in place that is working
in their best interests, NCAT may not make an order.
NCAT Guardianship Division Form | Guardianship application Page | 8
A guardian is not authorised to make decisions about the
person’s financial affairs. If you think this type of decision
need to be authorised you should apply for a financial
management order.
B. IS THERE A RISK TO THE PERSON?
You should tell NCAT about any possible risk to the
person. It may be a risk of:
· Becoming homeless
· Being abducted (removed without authority) from their
usual residence
· Has received an offer of accommodation that if not
accepted soon will expire
· Being physically abused or neglected
· Being exposed to verbal abuse, intimidation or conflict
· Requiring or refusing medical treatment or services
· Engaging in behaviour exposing them to harm or
danger
· An exploitative relationship.
C. WHO
DO YOU SUGGEST FOR THE ROLE OF
GUARDIAN?
You can suggest a guardian, however NCAT is not bound
to appoint that person. You should talk to the person before
nominating them. The person must be over 18 years and
suitable for the role because of their own experience.
If there is no one suitable or willing to take on the role of
guardian, NCAT will appoint the Public Guardian. The
Public Guardian is only appointed as the 'guardian of last
resort'. For more information visit the
Public Guardian
website.
7. APPLICATION CHECKLIST
I have attached all other documents relevant to this
application
Include all relevant information with your application. Refer
to the information on evidence and supporting materials.
Do not include any confidential information with your
application as copies of your attachments will be provided
to the other parties.
I have sent a copy of this application and attachments
to the Public Guardian
The Public Guardian is a statutory party to all NCAT
Guardianship Applications. You must send copies of all
documents, including this application and any attachments,
to the Public Guardian.
I have sent a copy of this application and attachments
to all other parties
You must send copies of all documents, including this
application and any attachments, to all other parties to the
application including the person the application is about.
I have made a copy of this application for my own
records
Before lodging your application with NCAT you must make
a copy of your application for your own records.
8. DECLARATION AND SIGNATURE
You must verify that all the information you have provided
to NCAT is true and correct. You must print your name and
sign and date the application form. If the application form is
submitted without being signed it may cause unnecessary
delays.
EVIDENCE AND SUPPORTING MATERIALS
At the hearing you will need to provide evidence to support
the decision. For a guardianship order, NCAT will generally
need a professional opinion about the person’s disability
and capacity to make personal and lifestyle decisions.
Your evidence may include reports prepared by:
· A doctor or other health or disability professional
· A lawyer or accountant involved in the person’s
financial affairs
· The provider of accommodation or services
· A counsellor or financial counsellor
· A social worker.
The evidence can be in the form of a report, statement,
statutory declaration or affidavit. At the hearing NCAT can
consider evidence that is in writing or given orally.
If the person has signed an appointment of an enduring
guardian a copy of it should be attached to the application.
All documents sent to NCAT must also be sent to the other
parties. You should not provide information that you do not
want disclosed to the other parties.
HOW CAN NCAT HELP ME?
If you have any questions about completing this form
please contact NCAT’s Guardianship Division on:
Telephone: (02) 9556 7600 or 1300 006 228
Email: gd@ncat.nsw.gov.au
Website: www.ncat.nsw.gov.au
WHERE CAN I LODGE MY APPLICATION
FORM?
To lodge your application, return all pages of the form to
NCAT’s Guardianship Division. Check that you have
completed all relevant items and signed the application
form. You can lodge the completed form and any
attachments by:
POST:
Guardianship Division
NSW Civil and Administrative Tribunal
PO Box K1026
Haymarket NSW 1240
IN PERSON:
NCAT Guardianship Division
Level 6 John Maddison Tower
86-90 Goulburn Street, Sydney
Office hours: 9am-5pm Monday to Friday (closed public
holidays)
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Gd Form Guardianship Application Guardianship Application

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Completed 11 July 2020

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