- Limited Continuing Power of Attorney - Ontario
- Combined Medical Power of Attorney and Living Will - West Virginia
- Limited Power of Attorney for Motor Vehicle Transactions - Indiana
- Power of Attorney Form - Alaska Division of Motor Vehicles
- Limited Power of Attorney - Wyoming
- Limited Power of Attorney Form - Maine
Fillable Printable Limited or Special Power of Attorney - Ontario
Fillable Printable Limited or Special Power of Attorney - Ontario
Limited or Special Power of Attorney - Ontario
LIMITED or SPECIAL POWER OF ATTORNEY
To: Her Majesty the Queen in Right of Canada, as represented by the Minister of Human Resources
and Skills Development to be styled Minister of Human Resources and Social Development
This LIMITED or SPECIAL POWER OF ATTORNEY is given by:
I appoint ________________________________ ______________________________ _
of
(Address)
(Full name of attorney/mandatary/donee)
__________________________ ______________________________ _____________
(Address)
to be my attorney/mandatary/donee or in the event that my attorney/mandatary/donee is un able to act by
reason
of his/her mental incapacity, court order, resignation or death, I appoint (this may be left blank)
____________________________________________________________________________
(Full name of attorney/mandatary/donee)
of ______________________________________ ______________________________ ______
(Address)
to enter into and endorse, on my behalf, a Direct Loan Agreement (Full-time or Part-time) with the Minister
of Human Resources and Skills Development to be styled Minister of Human Resources and Social
Development, and to obligate me to repay this loan, according to its terms.
I acknowledge that this power may be exercised for the accommodation or benefit of third persons or of my
attorney/mandatary/donee or substitute attorney/mandatary/donee with or without consideration.
I understand that my attorney/mandatary/donee or substitu te attorney/mandatary/donee must be at least 19
years old.
In accordance with the applicable Powers of Attorney Act o r other applicable pr ovincial legislat i on (i n New
Brunswick, the Property Act; in Newfoundland and Labrador, the Enduring Powers of Attorney Act; in
Ontario, the Substitute Decisions Act, 1992; in Quebec, the Civi l Code of Qué bec , in Saskatchewan, The
Powers of Attorney Act, 2002), I declare that this limited or special power of attorney may be exercised
during any subsequent legal incapacity or mental incompetency, mental incapacity or mental infirmity, on
my part.
Save and except for the purpose of entering into and endorsing a Direct Loan Agreement with the Minister
of Human Resources and Skills Development to be styled Minister of Human Resources and Social
Development, the execution of this document will not revoke any other continuing powers of attorney
previously executed by me and I expressly provide that there may be multiple continuing powers of
attorney. (Applicable where Pow e r of Attor ney gi ven in O nt ari o onl y )
You may deal with my attorney/mandatary/donee or substitute attorney/mand a tary/donee, as the case may
be, until you receive notice of my death or bankruptcy or notice of termination by a court order or until
notice of revocation by me of this power of attorney has been given in writing to you. You may deal with
my attorney/mand a tary/donee, until you receive no tice of the resignation, death, bankruptcy or mental
incapacity of my attorney/mand atary/donee. You may deal with my substitute attorney/mandatary/donee,
when applicable, until you receive notice of the resignation, death, bankruptcy, or mental incapacity of my
substitute attorney/ mandatary/donee. Until such notice has been given and acknowledged, all that my
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(Full name of don or/grantor/ mandator)
attorney/mandatary/donee or substitute attorney/mandatary/donee, as the case may be, will do in
accordance with this power of attorney is fully accepted and confirmed.
[I have expressly requested that this document be drawn up in the English language.
expressé
ment demandé que ce document soit rédigé en anglais. (Applicable where Power of Attorney
given in Queb ec only)]
In this document, “you” means Her Majesty the Queen in Right of Canada, as represented by the Minister
of Human Resources and Skills Development to be styled Minister of Human Resources and Social
Development.
J’ai
This Document has been signed and delivered by me at
this
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____________________________ ____________, _____________, _______________
(Month) (Year)(Day)
______________________________________________________________________________________
____________________________
itle
Signature of Party giving Power of Attorney
Signed by the Party giving the Power of Attorney in the presence of :
__________________________
Signature of Witness
____________________________
Signature of Witness
__________________________
Print Name and Address and Title Print Name and Address and T
of Witness of Witness
Wit
nessing Requirements:
2 Witnesses required in all provinces
Witnesses must not be the donor, attorney, substitute attorney, spouse or partner of the attorney or
substitute attorney, ch ild of the person giving power of attorney, or someone the p erson treats as his
or her child. Witnesses in all jurisdictions must be adults.
In Saskatchewan, the two witnesses must not be family members of either the grantor or the
attorney and this power of attorney must also be accompanied by witness certificates in the
prescribed f orm.
In Quebec, witnesses must not have any interest in the act.
Witnesses may be employees of the Government of Canada, any Financial In stitution acting as an
agent of disbursement on behalf of the Government of Canada or of the Service Provider (pursuant
to section 6.2 of the Canada Student Financial Assistance Act), except in Manitoba. In Manitoba, if
the enduring clause will apply, the witness must be one of the following:
o An individual registered under the Marriage Act to solemnize marriages;
o An individual qualified to be registered under the Marriage Act to solemnize marriages;
o A judge of the superior court;
o A justice of the peace, magistrate or provinci
al judge;
o A qualified medical practitioner;
o A notary public;
o A lawyer
o A member o f the RCMP;
o A peace office
_______________________________________________________________________________________
Signature of attorney/mandatary/donee)
_______________________________________________________________________________________
(Signature of substitute attorney/mandatary/donee)