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Information for contact person appointment—Act, s 51 (4) (c)

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Part 3Accessing voluntary assisted dying and death

11 Information for contact person appointment—Act, s 51 (4) (c)

The following information is prescribed:

(a)

the name and telephone number of the individual;

(b)

the name, home address or business address and telephone number of the person being appointed as the individual’s contact person (the appointee);

(c)

a statement that the appointee—

(i)

is an adult; and

(ii)

consents to the appointment; and

(iii)

acknowledges the functions and obligations of a contact person under the Act, including the obligations under the Act, section 69 (Giving approved substances to approved disposer if individual dies or contact person appointment ends—contact person);

(d)

if the contact person appointment is prepared by another person under the Act, section 51 (4) (b) (ii)—

(i)

the name of the person who prepared the appointment; and

(ii)

a statement that the person is an adult; and

(iii)

a statement that the person prepared the appointment; and

(iv)

a statement that the individual asked the person to prepare the appointment.

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