1Intro2Donor3Attorney(s)4Successor Attorney(s)5EPA Start6Property Matters7Will Authorisation8Consulting9Providing Info10Benefits11Gifts & Donations12Additional T&Cs Introduction This online questionnaire is designed to allow you to send us information we need to prepare your Enduring Power of Attorney for Property (EPA Property). Some quick notes on how people are referred to in this questionnaire. The EPA Property gives someone you trust the power to look after your money and property if you’re unable to. This person is called your Attorney. The person who gives the power is called the Donor. If you are completing this on behalf of the Donor, please note we also refer to that person as “you”. There are some compulsory questions – these are noted with an asterisk (*). There is guidance and pop up information within the questionnaire to help you along. There are 12 Sections. Each Section has a General or Additional Comments field at the end. This allows you to enter anything you want, and you should feel free to use this if you have any doubts or are unsure about what is being asked in the earlier parts of the Section. If you need to take a break from the questionnaire, you can do so by clicking the Save and Continue Later link at the bottom of each page and you will receive an email with a link to allow you to resume where you left off. Your answers will all be saved automatically. Once you have completed the questionnaire click the SUBMIT button on the last page (Section 12 – Additional Terms and Conditions) and an email will be sent to you and us with your answers. We will follow up with you as required and contact you to organise how the completed EPA Property can be “executed” (signed and witnessed by all the relevant people). For further information about Enduring Power of Attorney for property you might want to review the following resource available from the Office of Seniors. https://www.superseniors.msd.govt.nz/documents/epa-documents/standard-explanation-epa-property.pdf You can choose that your EPA for property to comes into effect only if you become mentally incapable. If you do, your attorney can act under the EPA only if a medical certificate states, or the Family Court decides that you are mentally incapable; or you can choose that your EPA comes into effect while you are mentally capable, your attorney can act under it as soon as it is signed and witnessed and can continue to act if you become mentally incapable. Your attorney cannot act after they receive notice that the EPA is terminated, their appointment is ended, or their authority is suspended. At any stage you can contact us with questions on 03 2189855. Section 2 - Donor Details & Previous EPAs In this section and the entire form, we will refer to the person giving the power of attorney as either "Donor" or "you"First Name(Required) Middle Name(s) Surname(Required) Gender Male Female Non-binary Address Street Address Suburb City Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Phone (Home and/or mobile)(Required) Date of Birth(Required) Day Month Year If you have someone at Mee & Henry you regularly deal with you can list them hereNo Particular ContactLiz HenryKrista SimBrandt AuldWendy SutherlandSuzanne HendersonEmma HowieGillian KennedySheree CaseyDo you have any previous EPA's This is my first EPA in relation to property I have one or more previous EPAs which I want to revoke I have one or more previous EPAs which need to be considered alongside this EPA If you want to maintain any other EPAs please provide details of those EPAs here so we can consider whether there is any overlapping or inconsistenciesIf you can, please upload a copy of all and any previous EPA Drop files here or Select files Max. file size: 512 MB. General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 3 - Attorney Details You can appoint one or more Attorneys to act on your property matters. These can be people and/or a Trustee Corporation Note that, for a person, an Attorney must be: not less than 20 years old, and not bankrupt, and not mentally incapable Attorney(s) to be appointed First Name Middle Name Surname Relationship to Donor/You Address Actions Edit Delete There are no Attorneys. Add Attorney Maximum number of attorneys reached. Attorney, if a Trustee Corporation Do you want your Attorneys, if more than one, to be able to act together, or can they act separately?(Required) Together Separately Unsure General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 4 - Successor Attorney(s) DetailsDo you want to appoint one or more successor Attorneys if your Attorney's appointment ends? Yes No Unsure Successor Attorney(s) Details First Name Middle Name Surname Relationship to Donor/You Address Actions Edit Delete There are no Successor Attorneys. Add Successor Attorney Maximum number of successor attorneys reached. Successor Attorney, if a Trustee Corporation Do you want your Successor Attorneys, if more than one, to be able to act together, or can they act separately? Together Separately Unsure General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 5 - When EPA Starts to OperateThis EPA comes into effect(Required) Only if I become mentally incapable While I am mentally capable, and in effect if I become mentally incapable General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 6 - Relevant Property MattersDo you want your Attorney(s) to act on your behalf of all or some of your property affairs(Required) All Some (Please fill details below) General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 7 - Authorisation of a WillDo you want the Family Court to be able to authorise your Attorney(s) to make a Will for you when you are no longer capable of making one? Yes No Unsure General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 8 - Consultation with othersDo you want your Attorney(s) or successor Attorney(s) to consult with anyone else before making decisions? Yes No Unsure The duty consult applies to: both my Attorney(s) and successor Attorney(s) my successor Attorney(s) only People to consult with First Name Middle Name Surname Relationship to Donor/You Address Actions Edit Delete There are no People to consult with. Add Person to consult with Maximum number of people to consult with reached. General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 9 - Providing InformationDo you want to name a person or people who your Attorney(s) need to give information to about how they are carrying out their role? Yes No Unsure Person Details First Name Middle Name Surname Relationship to you Address Information to be given to this person Actions Edit Delete There are no People. Add Person Maximum number of people reached. General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 10 - Attorney(s) and other benefitsDo you want to give your Attorney(s) authority to use your property for their own benefit? Yes No Unsure My Attorney(s) can act for their own benefit as stated here Do you want to give your Attorney(s) authority to use your property for the benefit of any other person or people? Yes No Unsure Details First Name Surname Relationship to donor My Attorney(s) can give this person the following benefits Actions Edit Delete There are no People. Add Person Maximum number of people reached. General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 11 - Celebratory gifts and donationsDo you want your Attorney(s) to use your property to provide celebratory gifts? Yes No Unsure My Attorney(s) may provide out of my property celebratory gifts of not than more than the following maximum value to the following people, including any born after the date of this Enduring Power of Attorney Person or Group Maximum Value ($) Actions Edit Delete There are no Gifts. Add Gift Maximum number of gifts reached. Do you want your Attorney(s) to use your property to provide charitable donations? Yes No Unsure My Attorney(s) may make out of my property annual donations of up to the following amounts to the named charities Charity Maximum Value ($) Actions Edit Delete There are no Donations. Add Donation Maximum number of donations reached. General or Additional CommentsIf you want to add anything more related to the above questions please do so here. Section 12 - Additional Terms and ConditionsMy EPA is subject to the following additional terms and conditions Δ
