Donor (Grantor) Full Name *

First

Last

Donor (Grantor) Address (Ontario) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Donor (Grantor) Phone Number *

Donor (Grantor) Email *

Email name Donor

Power of Attorney Type (Ontario) *

Attorney (Primary) Full Name *

First

Last

Attorney (Primary) Phone Number

Attorney (Primary) Email

Do you want to name a Substitute (Alternate) Attorney? *

Substitute (Alternate) Attorney Full Name

First

Last

Special Instructions / Restrictions for the Attorney(s) (Ontario)

Power of Attorney Questionnaire for Ontario