application for a guardianship order (including an … · is a guardian needed for all or specific...

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FORM AG1 (2017 revision) File No.

APPLICATION FOR A GUARDIANSHIP ORDER(INCLUDING AN INTERIM GUARDIANSHIP ORDER)

Guardianship of Adults Act

A - PERSON YOU ARE APPLYING ABOUT (‘THE ADULT’)

First Name/s: Surname:

Is the adult known by any other names? If so please specify:

Residential address:

Current address if not the same as residential address:

Gender:

Identifies as Aboriginal or Torres Strait Islander Yes No

Is the adult under 18 years of age? Yes No

Date of birth:

E-mail:

Phone:

Mobile phone:

Hospital Registration (HRN) No. (if known):

Does the adult require an interpreter?

Yes, Language: No

Please specify if the adult has any other needs or requirements which NTCAT may need to knowabout for the purposes of arranging a hearing.

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B - APPLICANT’S INFORMATION

First name/s: Surname:

Your relationship to the adult:

Postal Address:

E-mail:

Phone:

Mobile phone:

Important: The use of electronic media for the exchange of documents and other importantinformation in NTCAT proceedings is strongly encouraged. If you are able to provide an emailaddress it will be used for the service of documents and notices. If you have provided a mobilephone number NTCAT may send you SMS text messages with notifications about your matter.

C - DETAILS OF IMPAIRED DECISION MAKING CAPACITY1 OF THE ADULT

Why do you say the adult needs a guardian?

Is a guardian needed for all or specific matters (eg. personal matters2 or financial matters3)?

Does the adult know about the application?

Yes No

If no, please explain why:

1 The meaning of ‘Impaired Decision Making Capacity’ is set out in s 5 of the Guardianship of Adults Act.2 S3 of the Guardianship of Adult Act defines “personal matters.”3 S3 of the Guardianship of Adults Act defines “financial matters.”

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D - URGENT MATTERS - INTERIM GUARDIANSHIP ORDER4

Interim guardianship orders may be made if the adult is in urgent need of a guardianship order. Aninterim guardianship order will not be made unless there is genuine urgency.

Is an interim guardianship order required?

Yes No

Please set out the circumstances of urgency:

Does the adult have an advance personal plan within the meaning of the Advance PersonalPlanning Act or an enduring power of attorney? 5

Yes No Unsure

If yes, please provide details of the advance personal plan or enduring power of attorney or copiesif you have them.

4 S 20 of the Guardianship of Adults Act sets out when NTCAT can make an interim guardianship order. NTCAT mustreasonably believe the person has impaired decision making capacity and is in urgent need of a guardian.5 You can search for an advance person plan at the Office of the Public Trustee (NT) and for a registered enduringpower of attorney at the Office of the Registrar-General (NT).

E - ADVANCE PERSONAL PLAN OR ENDURING POWER OF ATTORNEY

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Who do you say should be guardian (may be more than one)?

you

another person

the Public Guardian

the Public Trustee (only for financial matters)

Please provide the following details for each proposed guardian (not required for Public Guardianor Public Trustee):

Guardian 1

Title and name:

Organisation (if any):

Address:

Relationship or interest with respect to the adult (if any):

E-mail:

Phone:

Is this person aware of this application? Yes No

Do they consent to act as guardian? Yes No

Guardian 2

Title and name:


Address:

Relationship or interest with respect to the adult (if any):

E-mail:

Phone:

F - DETAILS OF PROPOSED GUARDIAN

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Is this person aware of this application? Yes No

Do they consent to act as guardian? Yes No

SIGNATURE

Signature of applicant or applicant’s representative:6

Name:

Date:

6 A person signing as representative of a party warrants to NTCAT that he/she has the lawful authority to do so.

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Below is a list of some frequently used words in this application.

Meaning of ‘decision-making capacity ‘and ‘impaired decision-making capacity’ (see section 5)

(1) An adult has decision-making capacity if the adult has the capacity to:

(a) understand and retain information about the adult's personal matters and financialmatters; and

(b) weigh the information in order to make reasoned and informed decisions about thosematters; and

(c) communicate those decisions in some way.

(2) An adult is presumed to have decision-making capacity until the contrary is shown.

(3) An adult has impaired decision-making capacity if the adult's decision-making capacity isimpaired.

Definition of ‘financial matter’ and ‘personal matter’ (see section 3)

financial matter, for an adult, means a matter relating to the adult's property or financial affairs.

Examples for definition financial matter

1 Receipt and payment of money.

2 Banking.

3 Property (including real estate) ownership.

4 Investment and management of assets.

5 Carrying on a trade or business.

6 Insurance for an adult or the adult's property.

7 Legal matters relating to a financial matter, other than as mentioned in section Error!Reference source not found.(e).

personal matter, for an adult, means a matter relating to the adult's personal affairs (includinghealth care) or lifestyle.

Examples for definition personal matter

1 Accommodation.

2 Health care.

3 The provision of care services to the adult.

4 Employment.

5 Education and training.

6 Day-to-day living matters, such as diet and daily activities.

7 Relationships with other people, including decisions about who may or may not visit theadult.

8 Legal matters relating to a personal matter, other than as mentioned in section Error!

ADDITIONAL INFORMATION

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Reference source not found.(e).

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FORM AG2 (2017 revision) Matter No.

PROPOSED GUARDIAN DECLARATIONTO BE COMPLETED BY EACH PROPOSED GUARDIAN

(APART FROM PUBLIC GUARDIAN OR PUBLIC TRUSTEE)

PERSON THE SUBJECT OF GUARDIANSHIP APPLICATION


Residential Address:

Date of Birth (if known):

PROPOSED GUARDIAN

Title and name:


Date of Birth:

Address:

Relationship or interest with respect to the person (if any):

E-mail:

Phone:

DECLARATION

I [full name]

of [home or work address]

solemnly and sincerely declare as follows:

1. I consent to appointment as a guardian for [adult’s name] (‘the adult’).

2. I have read, and understand, the information set out at the end of this document under theheading “Eligibility for appointment as a guardian”.

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3. I have/do not have [cross one out] a criminal history that may affect my eligibility for appointment asguardian. [Attach details if applicable.]

4. I have/do not have [cross one out] personal interests that may conflict with the interests of the adult. [Attach

details if applicable.]

5. I have/have not [cross one out] at any time been declared a bankrupt. [Attach details if applicable.]

6. I have/have not [cross one out] been in a professional relationship with the adult. [Attach details if applicable.]

7. I have/do not have [cross one out] previous experience as a guardian. [Attach details if applicable.]

8. I wish to draw NTCAT’s attention to the following matters that may affect my suitability forappointment as guardian for the adult: [Write the matters below or on an attached sheet.]

I declare that the statements contained in this declaration and in any attachments are true and that I know

that it is an offence1 to make a declaration that is false in any material particular:

SIGNATURE:2……………………………………………….

DATE:

PLACE WHERE DECLARATION MADE:

1 Section 119 of the Criminal Code Act (NT) provides that a person making an unattested declaration that, in anymaterial particular, is to his or her knowledge false, is guilty of a crime and is liable to imprisonment for 3 years.

2 This unattested declaration does not need to be witnessed.

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Eligibility for appointment as a guardian

1. Before appointing a person as guardian for an adult NTCAT must be satisfied that the person iseligible for appointment.

2. A person is eligible if:

they are at least 18 years old;

they consent to the appointment; and

NTCAT is satisfied they are suitable for appointment as guardian for the adult.

3. In deciding whether you are suitable for appointment, NTCAT must take into account the followingmatters (which are listed in section 15(2) of the Guardianship of Adults Act):

(a) whether you are likely to comply with the Guardianship of Adults Act;

(b) your ability to properly exercise the authority of a guardian;

(c) the views and wishes of the adult;

(d) the desirability of preserving any existing support network for the adult;

(e) your compatibility with:

(i) the adult; and

(ii) any other person also proposed to be appointed as a guardian for the adult;

and

(iii) any other agent for the adult;

(f) your availability and accessibility to the adult and to other interested persons for the

adult;

(g) whether you have, or have had, a professional relationship with the adult, the nature

of that relationship and whether it is appropriate for an individual with that

relationship to be the adult's guardian;

(h) the extent to which your interests are likely to conflict with the adult's interests;

(i) your history and experience as a guardian or in a similar role in the Territory or

elsewhere;

(j) if it is proposed that you will have authority for financial matters – your bankruptcy

history (if any);

(k) your criminal history (if any) in the Territory or elsewhere;

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(l) any other matter the Tribunal considers relevant.

4. The purpose of the Proposed Guardian Eligibility Declaration is to allow you to disclose to NTCATmatters that might be relevant to its assessment whether you are suitable for appointment asguardian. If there are matters listed above that may affect your suitability for appointment asguardian (positively or negatively) they should be disclosed in the declaration. It is very importantthat you complete the declaration truthfully.

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FORM AG3 File No.

COVERSHEET AND GUIDELINES FOR REPORT BYMEDICAL PRACTITIONER OR OTHER HEALTH

PRACTITIONERGuardianship of Adults Act

SECTION A - PERSON WHO IS THE SUBJECT OF THE GUARDIANSHIP APPLICATION

(‘THE ADULT’)


Date of birth:

SECTION B - YOUR DETAILS


Postal Address:

E-mail: Ph: Mob:

SECTION C - YOUR RELEVANT PROFESSIONAL QUALIFICATIONS

[Here set out a short statement of the training and/or experience that mean you are qualified to express the opinions inthe attached report. You may, instead, include such a statement in the report.]

SECTION D – DETAILS OF PERSON WHO REQUESTED YOUR REPORT


Organisation (if applicable):

Postal Address:

E-mail: Ph: Mob:

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SECTION E – DECLARATION

I declare that:

I have prepared the attached report having considered the guidelines below; and

I have mentioned in the report all matters known to me that I believe may be relevant toNTCAT’s assessment whether the adult has impaired decision-making capacity.

Date:

………………………………………..

Signature

GUIDELINES

Overview

You have been requested to provide an expert opinion to assist NTCAT in determining whetherguardianship orders should be made for the adult.

These guidelines are designed to assist you in the preparation of your report. The guidelines:

identify the issues NTCAT must consider in reaching a decision whether a person requires aguardian; and

include suggestions regarding the structure your report should take.

This document is also intended to act as a coversheet for your report. You will need to fill out sectionsA to E above and attach the completed document to your report.

Impaired Decision Making Capacity

NTCAT may only make a guardianship order for an adult if satisfied that the adult has ‘impaireddecision-making capacity’. That expression is defined in the Guardianship of Adults Act as follows:

Meaning of ‘decision-making capacity ‘and ‘impaired decision-making capacity’






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The definitions of ‘personal matters’ and ‘financial matters’ are in largely self-explanatory terms andinclude the following examples:

personal matters: accommodation; health care; the provision of care services to the adult;employment; education and training; day to day living matters, such as diet and daily activities; andrelationships with other people, including decisions about who may or may not visit the adult.

financial matters: receipt and payment of money; banking; property (including real estate) ownership;investment and management of assets; carrying on a trade or business; and insurance.

Decision-making capacity may be impaired for the purposes of the Act even if the impairmentfluctuates, varies in extent, or relates to certain matters only. In such cases, NTCAT may need to‘tailor’ any guardianship order so as to properly reflect the nature and extent of the impairment.

Expert Evidence and the Assessment of Decision-Making Capacity

NTCAT will usually rely upon evidence from a number of sources in reaching a decision whether anadult has impaired decision-making capacity. The type and quantity of available evidence is likelyto vary according to the affected adult’s particular circumstances.

Apart from observational evidence (for example in the form of carers’ reports or evidence of familymembers), expert opinion evidence will usually be essential to any assessment of decision makingcapacity.

From NTCAT’s point of view, the critical considerations in evaluating expert opinion evidenceregarding decision-making capacity are these:

whether the expert has training or experience that means he or she is qualified to expressan opinion regarding the adult’s decision making capacity; and

whether the expert has clearly identified the basis for his or her opinion including any mattersthat might affect the reliability of that opinion.

The level of training and expertise required of an expert, as well as the level of detail NTCAT willwish to see in a report, is likely to vary. For adults affected by unusual conditions, or in cases wherean adult’s capacity may be impaired in particular respects only, there is likely to be a greaterrequirement for specialist expertise and detailed analysis.

Your report

NTCAT does not insist that your report follow a particular form.

You should, however, ensure that your report includes:

details of the consultations, tests and investigations undertaken in relation to the adult;

your diagnosis or assessment based on those consultations, tests and investigations;

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an explanation of the way/s (if any) in which the diagnosed condition/s affects the adult’sability to:

(a) understand and retain information about the adult's personal matters andfinancial matters; and

(b) weigh the information in order to make reasoned and informed decisions aboutthose matters; and


a forecast, including having regard to the adult’s prognosis, of whether those effects arelikely to continue, worsen or abate;

identification of any matters that might affect the reliability of the conclusions you havedrawn; and

a statement of your qualifications (if not already set out in section C above).

If you wish, you could use the words in bold text above as subject headings for your report.

PLEASE ATTACH YOUR REPORT FOLLOWING THIS PAGE.

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FORM AG4 File No.

PRIMARY CARER’S REPORTGuardianship of Adults Act

A - PERSON WHO IS THE SUBJECT OF THE APPLICATION FOR A GUARDIANSHIP

ORDER (‘THE ADULT’)


B - YOUR DETAILS


Postal Address:

E-mail:

Phone:

Mobile phone:


Your position:

Your relationship (if any) with the adult:

C - PLEASE COMMENT ON THE FOLLOWING AND IF POSSIBLE PROVIDE EXAMPLES TO

SUPPORT YOUR COMMENTS

C1 - NEED FOR GUARDIANSHIP:

What are your observations regarding the adult’s memory - short term and long term?

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What are your observations regarding the adult’s concentration and attention?

What are your observations regarding the adult’s consciousness and orientation in time and place?

What are your observations regarding the adult’s comprehension and ability to learn and processinformation?

What are your observations regarding the adult’s ability to plan and sequence activities and solveproblems?

What are your observations regarding the adult’s insight into nature of their disability and itsconsequent limitations on the adult’s daily life?

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What are your observations regarding the adult’s ability to make decisions and exercise judgmentrelevant to daily living?

C-2 HEALTH AND CARE NEEDS:

Is the adult affected by any diagnosed medical conditions? [please provide details]

Is the adult presently taking medications or undergoing any treatment? [please provide details]

Do you have any other observations regarding the adult’s current health and wellbeing?

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Are you aware of any planned surgery or other medical treatment for the adult? [please provide details]

Does the adult have any sensory impairments? [please provide details]

Does the adult have any physical Impairments? [please provide details]

What are your observations regarding the adult’s behaviour (temperament, interactions with others)?

What are your observations regarding the adult’s care needs and ability to perform activities of daily living(including types of assistance needed (eg prompts) and why it is needed)?

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What are your observations regarding the adult’s ability to initiate self-care (ie. what would happen if theywere left without assistance)?

C-3 FAMILY AND COMMUNITY INVOLVEMENT:

What are your observations regarding the adult’s interactions with their family members? [please providedetails of the nature and frequency of the interactions]

Does the adult receive visitors? [please provide details of the nature and frequency of the visits]

Does the adult visit their family or home community? [please provide details]

Are you aware of any social, cultural or other special needs of the adult? [please provide details]

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C-4 GUARDIAN (please complete only if the adult already has a guardian or guardians)

Have you had any dealings with adult’s guardian/s and if so do you have any observations regarding theirperformance of the role? (e.g. – interactions with the adult, responsiveness)

C-5 OTHER MATTERS

Are there any other matters you would like to bring to NTCAT’s attention regarding the need for guardianshiporders for the adult?

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SIGNATURE

Signature of primary carer:

Name:

Date:

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Below is a list of some frequently used words in this application.

Meaning of ‘decision-making capacity ‘and ‘impaired decision-making capacity’ (see section 5)







ADDITIONAL INFORMATION

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FORM AG5 File No.

APPLICATION TO VARY REVOKE OR REASSESS AGUARDIANSHIP ORDER

Guardianship of Adults Act (ss. 36 and 39)



Is the person known by any other names? If so please specify:

Current address:

Gender:

E-mail:

Phone:

Mobile phone:



Postal Address:

E-mail:

Phone:

Mobile phone:



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C- DETAILS OF CURRENT GUARDIANSHIP ORDER (if known)

Date of order:

NTCAT (or Local Court) proceeding number:

Revocation of the guardianship order.

Reassessment of the guardianship order.

Variation of the guardianship order. Please briefly state the variation sought:

E - REASONS FOR THE APPLICATION

Please briefly state below the reason/s for seeking the order:

D - ORDER BEING SOUGHT

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Is there an urgent need for the order? (Please only answer ‘yes’ in genuine circumstances ofurgency.)

Yes No

If ‘yes’, please set out the circumstances of urgency:

SIGNATURE


Name:

Date:


F - URGENT MATTERS

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FORM AG6 File No.

APPLICATION TO REGISTER AN INTERSTATEGUARDIANSHIP ORDER

Guardianship of Adults Act (s. 54)




Residential Address:


Gender:


Is the adult under 18 years of age? Yes No

Date of birth:

E-mail:

Phone:

Mobile phone:

Hospital Registration (HRN) No. (if known):

B - APPLICANT/S INFORMATION


Postal Address:

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E-mail:

Phone:

Mobile phone:



C - DETAILS OF INTERSTATE GUARDIANSHIP ORDER

Please attach a copy of the order to this application (if available).

State/Territory in which original order was made:

Court or tribunal:

Date of order:

Duration of order:

Guardian details (attach separate sheet if more than two – contact details are unnecessary ifguardian is also the applicant):

Guardian 1:


Postal Address:

E-mail:

Phone:

Mobile phone:

Guardian 2:


Postal Address:

E-mail:

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Phone:

Mobile phone:

D - REASONS FOR THE APPLICATION

Please briefly state the reasons for seeking to have the guardianship order registered in theNorthern Territory:

Is there an urgent need for registration of the interstate order? (Please only answer ‘yes’ ingenuine circumstances of urgency.)

Yes No


F - URGENT MATTERS

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SIGNATURE

IMPORTANT: By signing this form you declare that to the best of your knowledge information andbelief:

the interstate guardianship order remains in force; and there are no circumstances that might lead to the revocation or variation of the

guardianship order by the issuing court or tribunal.


Name:

Date:


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FORM AG7 File No.

MISCELLANEOUS APPLICATION


(NOTE: This form is for applications under the Guardianship of Adults Act for which no other form exists– e.g. applications under ss 33, 34 & 35 of the Guardianship of Adults Act. Before using this form,

please check that forms AG5 and AG6 are not suitable.)



Is the person known by any other names? If so please specify:

Current address:

Gender:

Identifies as Aboriginal or Torres Strait Islander Yes NoE-mail:

Phone:

Mobile phone:

B - APPLICANT/S INFORMATION


Postal Address:

E-mail:

Phone:

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Mobile phone:



C- DETAILS OF CURRENT GUARDIANSHIP ORDER (if known)

Date of order:


D – ORDER BEING SOUGHT:

Briefly state below the order sought1:

E - REASONS FOR THE APPLICATION

Briefly state below the reasons/s for seeking the order2:

1 Briefly state the order you are seeking. For example: “An order under section 34 of the Guardianship of Adults Act for the formerguardian to hand over all financial documents to me in my capacity as the new guardian.”2 Provide a brief summary of the facts and circumstances that make the order(s) sought necessary.

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E - URGENT MATTERS


Yes No


SIGNATURE


Name:

Date:


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FORM AG8 File No.

APPLICATION REGARDING HEALTH CARE ACTION UNDERTHE ADVANCE PERSONAL PLANNING ACT

Advance Personal Planning Act

A- PERSON YOU ARE APPLYING ABOUT (‘THE ADULT’)





Gender:


Date of birth:

E-mail:

Phone:

Mobile phone:

Hospital Registration (HRN) No.:


Yes, Language? No





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Postal Address:

E-mail:

Phone:

Mobile phone:


C - PROPOSED HEALTH CARE ACTION1

Please provide details about the health care action to which this application relates, including (ifknown) details of the time and place of the proposed health care action and who proposes to takethe action:

Why does the adult require the health care action?

1 ‘Health care’ and ‘health care action’ are defined under s3 of the Advance Personal Planning Act.

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D - ORDER(S) BEING SOUGHT

(NOTE: more than one option may be selected)

Order under section 41(2) of the Advance Personal Planning Act that an advance consentdecision by the adult about health care action be disregarded.

Consent decision under section 44 of the Advance Personal Planning Act. (NOTE: for consentdecisions that are urgently required in accordance with section 63 of the Advance PersonalPlanning Act see also section H below.)

E - GROUNDS FOR SEEKING THE ORDER(S)

Please briefly state the facts matters and circumstances relied upon in support of orders beingsought.2

2 Note that sections 40 to 44 of the Advance Personal Planning Act identify several matters relevant toNTCAT’s power to make orders regarding health care action, including that the adult has impaired decisionmaking capacity for making a consent decision about the health care action (see s. 40(b)).

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F – OTHER DECISION MAKER(S) FOR THE ADULT

F.1 Is the person the subject of a guardianship order?

No

Yes (please attach a copy of the order if available).

Date of order:



Guardian 1:


Postal Address:

E-mail:

Phone:

Mobile phone:

Guardian 2:


Postal Address:

E-mail:

Phone:

Mobile phone:

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F.2 Does the adult have an advance personal plan within the meaning of the Advance PersonalPlanning Act or an enduring power of attorney within the meaning of the Powers ofAttorney Act? 3

No

Yes (please provide details below of the advance personal plan or enduring power ofattorney, or attach a copy if you have one).


Yes No


3 An advance personal plan can searched for at the Office of the Public Trustee (NT) and a registered enduring power ofattorney can be searched for at the Office of the Registrar-General (NT).4 If this is an application to which section 63 of theAdvance Personal Planning Act Applies (see Part G) the applicant must sign personally.

G - URGENT MATTERS (SEE ALSO PART H FOR URGENT APPLICATIONS AFFECTED

BY SECTION 63 OF THE ADVANCE PERSONAL PLANNING ACT)

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Is this an application to which section 63 of the Advance Personal Planning Act applies?

No

Yes.

If ‘yes’, the applicant makes the following declaration by signing this form.

I declare that:

1. I am a medical practitioner.

2. This is an application for an order under section 44 of the Advance Personal Planning Actin relation to health care action proposed to be taken in relation to the adult, who is mypatient.

3. I reasonably believe that a consent decision about the health care action is urgentlyrequired.

4. The reasons for my belief are set out in Part G of this form.

SIGNATURE

Signature of applicant4 or applicant’s representative:5

Name:

Date:

4 If this is an application to which section 63 of the Advance Personal Planning Act Applies (see Part G) the applicant must signpersonally.5 A person signing as representative of a party warrants to NTCAT that he/she has the lawful authority to do so.

H – URGENT CONSENT DECISION – DECLARATION BY MEDICAL PRACTITIONER FOR

THE PURPOSES OF SECTION 63 OF THE ADVANCE PERSONAL PLANNING ACT

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FORM AG9 File No.

ASSET MANAGEMENT PLANGuardianship of Adults Act

REPRESENTED PERSON


GUARDIAN DETAILS

Guardian 1


Postal Address:

E-mail:

Phone:

Mobile phone:

Guardian 2 (If more than one guardian)


Postal Address:

E-mail:

Phone:

Mobile phone:

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WHY IS AN ASSET MANAGEMENT PLAN REQUIRED?

Section 32 of the Guardianship of Adults Act provides that a guardian (other than the PublicGuardian or Public Trustee) with authority for financial matters of a represented person mustprepare an asset management plan if ordered to do so by the Tribunal.

Section 32(2)(b) provides that a guardian must, as far as reasonably practicable, manage therepresented person’s property in accordance with the asset management plan.

The Tribunal will review a guardian’s management of the represented person’s property whenconducting a reassessment of a guardianship order. The Tribunal will review both the assetmanagement plan (if one has been ordered) and the financial statement (which is required to besubmitted immediately before the reassessment – see form AG10). This is then considered in thecontext of re-appointing the relevant guardian.

WHAT IS AN ASSET MANAGEMENT PLAN?

An asset management plan is a plan designed to make sure that a represented person’s needsand wants can be met from the financial resources available to them.

Needs and wants

A represented person’s needs and wants will include matters common to most people – such asaccommodation, meals, clothing, medical and health care, entertainment and travel – but may alsoinclude matters very specific to the person, such as, for example, a wish to retain a treasuredpossession, or to support a particular person or charity, or to provide an inheritance.

A represented person’s needs and wants are likely to change over time. An asset managementplan should therefore take into account not only the represented person’s immediate requirements,but their requirements over the whole period they are likely to need a guardian - which will often bethe rest of their life.

Some changes in personal circumstances cannot be predicted, so a plan should also take intoaccount the possibility of ‘rainy days’.

Available financial resources

A represented person’s available financial resources will include their income sources, savings andsaleable property - after any tax or other liability - but may also include resources contributed byanother person (for example a parent or spouse).

Just as the represented person’s needs and wants will often change over time, so too may theiravailable financial resources. Asset management planning should therefore include consideration

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of the possibility that more, or less, money will become available for the represented person in thefuture.

Telling NTCAT about your plan

In the next section of this form there are two questions.

The questions concern your plan for the time of your current appointment and also for the entireperiod the represented person is likely to require a guardian for financial matters.

Before answering them you will need to carefully:

consider the represented person’s needs and wants; and

estimate their available financial resources.

Professional assistance

NTCAT does not require an asset management plan to be professionally prepared. However, forrepresented persons with large personal estates, or where legal arrangements concerning aperson’s financial resources are complicated, a guardian may consider that it is in the representedperson’s best interests to obtain the assistance of an accountant, financial advisor or lawyer.

(PLEASE TURN TO NEXT PAGE)

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WHAT IS YOUR PLAN FOR ENSURING THAT THE REPRESENTED PERSON’S WANTS

AND NEEDS ARE ABLE TO BE MET FROM THE FINANCIAL RESOURCES AVAILABLE

TO THEM FOR THE PERIOD OF YOUR CURRENT APPOINTMENT AS GUARDIAN FOR

FINANCIAL MATTERS?

(Attach a separate sheet if insufficient space.)


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WHAT IS YOUR PLAN FOR ENSURING THAT THE REPRESENTED PERSON’S WANTS

AND NEEDS ARE ABLE TO BE MET FROM THE FINANCIAL RESOURCES AVAILABLE

TO THEM FOR THE ENTIRE PERIOD THEY ARE LIKELY TO REQUIRE A GUARDIAN FOR

FINANCIAL MATTERS?

(Attach a separate sheet if insufficient space.)


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GUARDIAN 1

I declare that I have prepared the plan described in my answers to the questions above having made all the

inquiries I considered necessary in order to ensure that the plan is realistic and achievable.

…………………………………………….SIGNATURE

(insert full name)

on

at

(insert place)

GUARDIAN 2

I declare that I have prepared the plan described in my answers to the questions above having made all the

inquiries I considered necessary in order to ensure that the plan is realistic and achievable.

…………………………………………….SIGNATURE

(insert full name)

on

at

(insert place)

DECLARATION BY GUARDIAN/S

(insert date)

(insert date)

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FORM AG10 File No.

FINANCIAL STATEMENT1


REPRESENTED PERSON (‘RP’)


Current address:

Living arrangements: Rent Own

Care Facility Other – please specify:

GUARDIAN DETAILS (FOR GUARDIANS WITH AUTHORITY AS TO FINANCIAL

MATTERS)

Guardian 1


Postal Address:

E-mail:

Phone:

Mobile phone:

Guardian 2 (If more than one guardian)


Postal Address:

E-mail:

Phone:

Mobile phone:

1 Only guardians with authority as to financial matters need to complete and sign this form.

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REPORTING PERIOD

The reporting period for this report is the period from your appointment or re-appointment as guardian to thedate of this report.

The parts of this report dealing with income and expenditure will require details for individual financial yearswithin the reporting period.

SHARED ASSETS OR LIABILITIES

If the RP shares an asset or liability with someone else, only the value of their share should bereferred to and recorded in this report.

INCOME

What was the RP’s (before tax) income during the reporting period?

Type of income Financial Year: Financial Year: Financial Year:

Pension and other governmentbenefits and subsidies

Employment

From investments (includingsuperannuation)

Other (please specify):

Total:

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EXPENDITURE

What have you spent on the RP’s behalf during the reporting period?

Type of expense Financial Year: Financial Year: Financial Year:

Daily living expenses (eg. food,clothing, medical/health care,entertainment etc)

$ $ $

Accommodation $ $ $

Utilities (eg. power, water, gas) andCouncil rates

$ $ $

Insurance $ $ $

Loan repayments $ $ $

Taxation $ $ $

Guardian fees $ $ $

Other (please specify): $ $ $

Total: $ $ $

Were any of the expenses included in the amounts above, one-off (ie. non-recurring) expenses of$500.00 or more?

Yes No

If yes please provide details of each expense:

Date Amount Reason for Expense

$

$

$

$

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Did you spend the RP’s funds directly on or for the RP?

Yes No

If no, please provide details of each expense:

Date Amount Reason for Expense

$

$

Please:

list in the table below the bank savings, cheque or other investment accounts of the RP forwhich you have authority; and

attach to this report a copy of a statement for each account listed for the entire reportingperiod. Clearly mark with a letter each statement corresponding to the letter on the list.

FinancialInstitution

Type of Account2 AccountNo.

JointAccountY/N

CurrentBalance

A. $

B. $

C. $

D. $

Other Financial Assets Co-owned?Y/N

Value (RP’sshare)

Superannuation $

Shares $

Life Insurance $

2 For example savings, cheque, credit or loan.

ASSETS

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Accommodation Bond $

Other $

Total: $

Real Estate Co-owned?Y/N

Value (RP’sShare)

Amount Owed (ifmortgaged)

Net Value

Real estate 1Address of property

$ $

Real estate 2- if applicableAddress of property

$ $

Accommodation Bond3 $ $

Total: $

For the value(s) given above what was the basis4 for your valuation?

Professional valuation by a licensed valuer Market survey

Estimate Other, Please specify:

Personal Property Co-owned?Y/N

Value (RP’sShare)

Vehicles $

All other items (estimated) $

Total: $

3 This includes accommodation bonds held by a an aged care facility.

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Does the total shown for personal property include individual personal assets (excluding vehicles)for which the value of the RP’s share is $5,000.00 or more? If so, please specify in the below table.

Personal Property Value of RP’s Share

$

$

$

Total: $

Did you dispose of any of the RP’s assets worth $2,000 or more during the reporting period?

Yes No

If yes please provide details:

Asset Disposed Of Date AssetDisposed Of

Reason for Disposal Value

$

$

Please: list in the table below the RP’s loan, credit, mortgage or other similar accounts for which

you have authority; and attach to this report a copy of a statement for each account listed for the entire reporting

period. Please clearly mark each statement with a letter corresponding to the letter in thelist.

5 Disposal includes sale, gift, transfer or destruction.

DISPOSAL5 OF ASSETS

CURRENT LIABILITIES

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FinancialInstitution

Type of Account6 AccountNo.

JointAccountY/N

CurrentBalance

E. $

F. $

G. $

H. $

Other Debts Owing Amount owing

Taxation debt $

Personal debt(s) $

Other $

Total: $

Are you aware:

expenses of $5,000 or more the RP is likely to incur; or debts of $5,000 or more that will become owing by the RP within 1 year from the date of

this report?

Yes No

If yes, please provide details of each debt or expense:

Debt or expense Estimated amount

$

$

$

Total: $

6 For example savings, cheque, credit or loan.

FUTURE DEBTS, EXPENSES AND LIABILITIES OVER $5,000.00

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GUARDIAN 1

I declare that the information provided and statement/s contained in this declaration is/are true and I know


SIGNATURE8

(insert full name)

on

at

(insert place)

GUARDIAN 2

I declare that the information provided and statement/s contained in this declaration is/are true and I know


SIGNATURE10

(insert full name)

on

at

(insert place)

7 Section 119 of the Criminal Code Act (NT) provides that a person making an unattested declaration that, in anymaterial particular, is to his or her knowledge false, is guilty of a crime and is liable to imprisonment for 3 years.

8 This unattested declaration does not need to be witnessed.9 See footnote 6.10 See footnote 7.

DECLARATION BY GUARDIAN/S

(insert date)

(insert date)

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FORM AG8A File No.

OTHER APPLICATION UNDER THE ADVANCE PERSONALPLANNING ACT

Advance Personal Planning Act

(NOTE: This form is for applications under the Advance Personal Planning Act other than applicationsrelating to consent decisions about health care action – for which form AG8 should be used.)

A- PERSON YOU ARE APPLYING ABOUT (‘THE ADULT’)





Gender:


Date of birth:

E-mail:

Phone:

Mobile phone:

Hospital Registration (HRN) No.:


Yes, Language? No


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Postal Address:

E-mail:

Phone:

Mobile phone:


C – ORDER BEING SOUGHT:

Briefly state below the order sought (including the applicable section(s) of the Advance PersonalPlanning Act)1:

1 For example: “An order under section 61 of the Advance Personal Planning Act revoking the advance personal plan signed by [theadult] on [date].”

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D - GROUNDS FOR THE APPLICATION

Briefly state below the reasons/s for seeking the order2:

E – DECISION MAKER(S) FOR THE ADULT (IF ANY)

E.1 Is the person the subject of a guardianship order?

No

Yes (please attach a copy of the order if available).

Date of order:


2 Provide a brief summary of the facts and circumstances that you may make the order(s) sought necessary.

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Guardian 1:


Postal Address:

E-mail:

Phone:

Mobile phone:

Guardian 2:


Postal Address:

E-mail:

Phone:

Mobile phone:

E.2 Does the adult have an advance personal plan within the meaning of the Advance PersonalPlanning Act or an enduring power of attorney within the meaning of the Powers ofAttorney Act?3

No

Yes (please provide details below of the advance personal plan or enduring power ofattorney, or attach a copy if you have one).

3 An advance personal plan can searched for at the Office of the Public Trustee (NT) and a registered enduring power of attorney canbe searched for at the Office of the Registrar-General (NT).

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E - URGENT MATTERS

Is there an urgent need for the order(s)? (Please only answer ‘yes’ in genuine circumstances ofurgency.)

Yes No


SIGNATURE


Name:

Date:


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STANDARD ORDERS – APPLICATION IN EXISTING GUARDIANSHIP PROCEEDING

1. The application is listed for a directions hearing at <place> on < drg hrg date [adopt default

of 2 weeks from orders, changeable by Registrar]> at <time>.

2. By no later than <d hrg date minus 2 business days> <the applicant/applicants> shall provide

a copy of <the form AG5/AG7> and these orders to the following:

a. the adult;

b. each guardian for <the adult> (apart from the Public Guardian, the Public Trustee);1

c. each person who is both:

an interested person for the adult within the meaning of the Guardianship

of Adults Act; and

someone who may wish to have their views taken into account regarding

the application.

3. The following are expected to participate in the directions hearing:

a. <the applicant/applicants>;

b. the Public Guardian;

c. each guardian for <the adult>; and

d. any person referred to in order 2.c who wishes to have their views taken into

account regarding the application.

4. The adult is encouraged to participate in the directions hearing.

5. A person wishing to participate in the directions hearing by video or telephone must make

prior arrangements to do so with the tribunal.

6. A person intending to participate in the directions hearing should read the information set

out at the end these orders.

1 Note that NTCAT will provide a copy of these orders to the Public Guardian (and to the Public Trustee ifinvolved in the proceeding).

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STANDARD ORDERS – NEW GUARDIANSHIP PROCEEDINGS (NON-URGENT)

1. The proceeding is listed for a directions hearing at <place> on <d hrg date [adopt default of 4

weeks from acceptance, changeable by Registrar]> at <time>.

2. By no later than <d hrg date [minus 2 weeks> the <applicant/applicants> are to provide a

copy of the form AG1 and these orders to the following:

a. the adult;

b. each proposed guardian for the adult (apart from the Public Guardian, the Public

Trustee or any proposed guardian who is also an applicant);1



of Adults Act; and


the making of guardianship orders for the adult.

3. By no later than <d hrg minus 1 week> the <applicant/applicants> is/are to provide written

notice to NTCAT of the persons to whom the form AG1 and these orders have been provided

under order 1.


a. the applicant;


c. each proposed guardian; and


account regarding the making of guardianship orders for the adult.






1 Note that NTCAT will provide a copy of the AG1 and these orders to the Public Guardian (and to the PublicTrustee if involved in the proceeding).

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STANDARD ORDERS – NEW GUARDIANSHIP PROCEEDINGS (INTERIM ORDER SOUGHT)

(NOTE: the purpose of these orders is to ensure that as many relevant parties as possible are made

aware of the application for interim orders and the material relied upon in support of the application.

The urgency of a matter may make full compliance with the orders difficult; however they should be

complied with to the full extent possible in the circumstances.)

1. The application for interim guardianship orders for <the adult> is listed for hearing on

<interim hrg date [Registrar to determine having regard to circumstances of urgency

indicated in application]> at <time>.

2. By no later than <interim hrg date> the <applicant/applicants> are to provide a copy of the

form AG1 and these orders to the following:

a. <the adult>;

b. each proposed guardian for <the adult> (apart from the Public Guardian, the Public

Trustee or any proposed guardian who is also an applicant);1



of Adults Act; and



3. By no later than <interim hrg date> the <applicant/applicants> is/are to provide to each of:

NTCAT;

the Public Guardian;

the Public Trustee (if proposed as a guardian); and

the persons referred to in order 2 to whom the form AG1 and these orders have

been provided;

copies of the following documents:

a. a proposed guardian eligibility declaration in form AG2 for each proposed guardian

for <the adult>;

b. a report in form AG3 regarding the decision making capacity of <the adult>;

c. a primary carer’s report relating to <the adult> in form AG4; and

1 Note that NTCAT will provide a copy of the AG1 and these orders to the Public Guardian (and to the PublicTrustee if involved in the proceeding).

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d. any other evidence upon which the applicant/applicants intend relying at the

hearing of the application for interim guardianship orders.

4. If the Public Guardian or the Public Trustee prepares a report or other evidence for the

purposes of the hearing of the application for interim guardianship orders, it shall provide a

copy to:

NTCAT; and

the applicant/applicants;

and the applicant/applicants shall provide a copy to each of the persons referred to in order

2 to whom the form AG1 and these orders have been provided.

5. The following are expected to participate at the hearing of the application for interim

guardianship orders:

a. the applicant/applicants;

b. for applications concerning the adult’s presence or treatment at a health care facility

- a person or persons directly involved in <the adult>’s care at the facility;

c. the Public Guardian;

d. each proposed guardian; and

e. any person referred to in order 2.c who wishes to have their views taken into

account regarding the making of interim guardianship orders for the adult.

6. The adult is encouraged to participate at the hearing of the application for interim

guardianship orders.

7. A person wishing to participate in the hearing by video or telephone must make prior

arrangements to do so with the tribunal.

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(note: these SOs will issue approx. 4 weeks prior to date for directions hearing)

STANDARD ORDERS – REASSESSMENT OF GUARDIANSHIP ORDER

1. The proceeding is listed for a directions hearing at <place> on <d hrg date [this will be

reassessment date from last NTCAT order or review deadline from last Local Court order]> at

<time>.

2. By no later than <d hrg date minus two weeks> the <guardian/guardians [as appointed

under previous order]> are to provide a copy of these orders to the following:

a. the adult;

b. any proposed new guardian for the adult (apart from the Public Guardian, the Public

Trustee);1



of Adults Act; and




notice to NTCAT of the persons to whom these orders have been provided under order 2.


a. the <guardian/guardians>;


c. any proposed new guardian for <the adult>; and


account regarding the making of guardianship orders for the adult.




1 Note that NTCAT will provide a copy of these orders to the Public Guardian (and to the Public Trustee ifinvolved in the proceeding).

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STANDARD ORDERS

URGENT APPLICATION - SECTION 63 OF THE ADVANCE PERSONAL PLANNING ACT


aware of the application and the material relied upon in support of the application. They should be

complied with to the full extent possible in the circumstances.)

1. The application for orders under sections 44 and 63 of the Advance Personal Planning Act for

<the adult> is listed for hearing on <date within 24 hours of orders> at <time within 24 hours

of orders>.

2. AS SOON AS POSSIBLE <the applicant/applicants> shall provide to NTCAT a copy of the

evidence upon which they intend relying at the hearing of the application.

3. AS SOON AS POSSIBLE <the applicant/applicants> shall provide a copy of:

the <form AG8 > and these orders; and

the evidence upon which they intend relying at the hearing of the application;

to the following:

a. the adult;


c. each person (if any) who is an agent1 for the adult within the meaning of the

Advance Personal Planning Act;2 and

d. each other person (if any) who is both:

an interested person3 for the adult within the meaning of the Advance

Personal Planning Act; and


the application.

4. The following are expected to participate at the hearing of the application:

1 Under the Advance Personal Planning Act ‘agent’, for an adult, means a decision maker, adult guardian orenduring attorney for the adult or other person who has lawful authority to manage the adult's affairs2 Note that NTCAT will provide a copy of the <form AG8/AG8A> and these orders to the Public Guardian (andto the Public Trustee if affected by the application).3 Under the Advance Personal Planning Act ‘interested person’ means any of the following (a) a decisionmaker for the adult; (b) an adult guardian for the adult; (d) enduring attorney for the adult; (e) a health careprovider for the adult; (f) the Chief Executive Officer; (g) the Public Guardian; (h) the Public Trustee; (i) anotherperson who has a genuine and sufficient interest in protecting the adult's best interests.

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b. the Public Guardian; and

c. any other person referred to in order 3 who wishes to have their views taken into


5. The adult is encouraged to participate at the hearing of the application.



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STANDARD ORDERS – PROCEEDINGS UNDER ADVANCE PERSONAL PLANNING ACT – URGENT

MATTERS


aware of the application and the material relied upon in support of the application. The urgency of a

matter may make full compliance with the orders difficult; however they should be complied with to

the full extent possible in the circumstances.)

1. The application for orders under the Advance Personal Planning Act for <the adult> is listed

for hearing on <ugt hrg date [Registrar to determine having regard to circumstances of

urgency indicated in application]> at <time>.

2. By no later than <ugt hrg date> <the applicant/applicants> shall provide a copy of the <form

AG8/AG8A> and these orders to the following:

a. the adult;

b. each person (if any) who is an agent1 for the adult within the meaning of the

Advance Personal Planning Act (apart from the Public Guardian, the Public Trustee

or any proposed guardian who is also an applicant);2 and

c. each other person (if any) who is both:




the application.

3. By no later than <ugt hrg date> <the applicant/applicants> shall provide copies of the

evidence upon which they intend relying at the hearing of the application to each of:

NTCAT;

the Public Guardian;

the Public Trustee (if affected by the application); and

the persons referred to in order 2 to whom the <form AG8/8A> and these orders

have been provided;

1 Under the Advance Personal Planning Act ‘agent’, for an adult, means a decision maker, adult guardian orenduring attorney for the adult or other person who has lawful authority to manage the adult's affairs2 Note that NTCAT will provide a copy of the <form AG8/AG8A> and these orders to the Public Guardian (andto the Public Trustee if affected by the application).3 Under the Advance Personal Planning Act ‘interested person’ means any of the following (a) a decisionmaker for the adult; (b) an adult guardian for the adult; (d) enduring attorney for the adult; (e) a health careprovider for the adult; (f) the Chief Executive Officer; (g) the Public Guardian; (h) the Public Trustee; (i) anotherperson who has a genuine and sufficient interest in protecting the adult's best interests.

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4. If the Public Guardian or the Public Trustee prepares a report or other evidence for the

purposes of the hearing of the application, it shall provide a copy to:

NTCAT; and

<the applicant/applicants>;

and <the applicant/applicants> shall provide a copy to each of the persons referred to in

order 2 to whom the <form AG8/8A> and these orders have been provided.

5. The following are expected to participate at the hearing of the application:


b. each person referred to in order 2.b; and

c. any person referred to in order 2.c who wishes to have their views taken into


6. The adult is encouraged to participate at the hearing of the application.



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STANDARD ORDERS – PROCEEDINGS UNDER ADVANCE PERSONAL PLANNING ACT

1. The proceeding is listed for a directions hearing at <place> on <d hrg date [adopt default of 4

weeks from acceptance, changeable by Registrar]> at <time>.

2. By no later than <d hrg date [minus 2 week]> the <applicant/applicants> are to provide a

copy of the <form AG8/AG8A> and these orders to the following:

a. the adult;

b. each person (if any) who is an agent1 for the adult within the meaning of the

Advance Personal Planning Act (apart from the Public Guardian, the Public Trustee

or any proposed guardian who is also an applicant);2

c. each other person (if any) who is both:




the application.


notice to NTCAT of the persons to whom the form AG8/8A and these orders have been

provided under order 2.


a. the applicant/applicants;

b. each person referred to in order 2.b; and

c. any person referred to in order 2.c who wishes to have their views taken into





1 Under the Advance Personal Planning Act ‘agent’, for an adult, means a decision maker, adult guardian orenduring attorney for the adult or other person who has lawful authority to manage the adult's affairs2 Note that NTCAT will provide a copy of the AG1 and these orders to the Public Guardian (and to the PublicTrustee if involved in the proceeding).3 Under the Advance Personal Planning Act ‘interested person’ means any of the following (a) a decisionmaker for the adult; (b) an adult guardian for the adult; (d) enduring attorney for the adult; (e) a health careprovider for the adult; (f) the Chief Executive Officer; (g) the Public Guardian; (h) the Public Trustee; (i) anotherperson who has a genuine and sufficient interest in protecting the adult's best interests.

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application for a guardianship order (including an … · is a guardian needed for all or specific...

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