# Office for Seniors — Enduring Power of Attorney in relation to personal care and welfare: notes, form and witness certificate

- Document ID: doc-0111
- Publisher: Office for Seniors, Ministry of Social Development
- Catalogue document/publication label: July 2021
- Physical pages in preserved original: 15
- Original capture/access label: June 2026
- Evidence reviewed: 9 October 2026

[Preserved original](/pdfs/2021%20-%20Office%20for%20Seniors%20-%20EPA%20Personal%20Care%20and%20Welfare%20Form.pdf) · [Primary source](https://www.officeforseniors.govt.nz/our-work/promoting-enduring-power-of-attorney/how-to-create-an-enduring-power-of-attorney)

## Synopsis

Personal care and welfare EPA package: five pages of notes, seven appointment pages and three witness-certificate pages; current Office for Seniors PDF matches the preserved original.

## What this document contributes

The preserved personal care and welfare EPA package contains five pages of notes and glossary, seven pages of appointment form and a three-page donor-witness certificate. It helps a prospective donor consider an attorney and successors, the matters covered, prior EPAs, consultation, information sharing and conditions before obtaining professional advice and witnessing. The current Office for Seniors PDF is byte-identical to this original. Its notes distinguish significant decisions requiring incapacity certification or a court decision from other decisions based on reasonable grounds, and set out limits on attorney powers. The publisher lists July 2021, while PDF modification metadata is September 2021; neither supplies a verified exact first-publication day. The blank package is not an executed EPA or a capacity assessment.

## Package contents

- Physical pp.1–5: Notes and glossary (separate printed numbering 1–5 of 5).
- Physical pp.6–12: Personal care and welfare EPA appointment form (separate printed numbering 1–7 of 7).
- Physical pp.13–15: Certificate of witness to donor signature (separate printed numbering 1–3 of 3).

## Substantive findings

- Fifteen physical pages comprise notes/glossary (1–5), appointment form (6–12) and donor-witness certificate (13–15), each with separate printed numbering. Original physical page references: 1, 5, 6, 12, 13, 15.
- One personal care/welfare attorney may be appointed under this EPA; successor appointments are separate. This contrasts with multiple property attorneys. Original physical page references: 1, 7, 8. [Additional primary source](https://www.officeforseniors.govt.nz/our-work/promoting-enduring-power-of-attorney/how-to-create-an-enduring-power-of-attorney).
- The notes distinguish incapacity evidence for significant matters from reasonable grounds for other matters, with capacity considered at the time and for the decision concerned. Original physical page references: 1, 2. [Additional primary source](https://www.officeforseniors.govt.nz/our-work/promoting-enduring-power-of-attorney/when-an-epa-comes-into-effect).
- The notes describe supporting the donor’s own decisions, promoting welfare and best interests, considering prior wishes, consultation and coordination with another EPA attorney. Original physical page references: 2.
- The notes list decisions an attorney cannot make, including refusing standard treatment intended to save life or prevent serious harm. The appointment is not unlimited medical consent authority. Original physical page references: 2.
- The form allows specified care/welfare scope, successor appointments, consultation recipients, information recipients and added conditions; named information recipients provide an oversight mechanism. Original physical page references: 7, 8, 9, 10, 11.
- The final three pages certify witness qualification, how the donor signed, independence/exceptions, explanation, understanding, absence of undue pressure and no reason to suspect incapacity at signing. Original physical page references: 13, 14, 15.
- Current Office for Seniors PDF is byte-identical to the original. Justice’s care/welfare Word version differs in three Ms/Miss title fields in normalized-text comparison; file equivalence must be format-specific. Original physical page references: 1. [Additional primary source](https://www.justice.govt.nz/family/powers-to-make-decisions/the-court-and-enduring-power-of-attorney-epa/).

## Uses and implications

Prepare a care/welfare EPA adviser appointment by considering the attorney, successors, wishes, scope and oversight. Use the notes to distinguish signing the instrument from later decision-specific activation, while checking current official guidance.

- Discuss care wishes, successors, consultation and information recipients before the adviser appointment.
- Signing a blank form and later activating an EPA are different steps; incapacity evidence depends on the decision concerned.
- The witness certificate and required signatures must be addressed with an authorised professional; the blank package is not an executed EPA.

Intended readers: Prospective care/welfare EPA donors; Whānau and supporters discussing future care wishes; Attorneys and advisers checking package contents.

- Care/welfare guidance should distinguish significant decisions from other decisions and retain the donor’s participation and decision-specific capacity.
- Publish complete packages with the notes and certificate, and make official-format differences transparent.

## Identity, dates and provenance

- Publisher resource publication month: July 2021
- PDF creation metadata: 2021-07-26T16:22:43+12:00
- PDF modification metadata: 2021-09-22T13:38:31+12:00
- Exact original first publication: Not established
- Original capture label: June 2026
- Primary-source evidence review: 2026-10-09

Technical metadata, webpage updates, statutory version/effective dates and publisher publication labels are distinct. A missing exact first-publication day is not supplied from metadata or the review date.

The original PDF and filename are preserved. SHA-256: `5c6974eaf1a89f5593bea12be0a054e477e30fb17ccb1f4bb757f855707679d5` (403,084 bytes). On 9 October 2026 the [Office for Seniors PDF](https://www.officeforseniors.govt.nz/assets/documents/our-work/EPA/Enduring-power-of-attorney-in-relation-to-personal-care-and-welfare-.pdf) was byte-identical to this original. This comparison does not extend to all official Word/PDF formats.

## Official format differences

The normalized XML-text comparison of current Office and Justice care/welfare Word forms finds three Ms/Miss title-field differences. Word layout and legal effect were not inferred from this comparison.

## Evidence limits

Blank official package, not an executed instrument, certification that a donor has capacity, clinical assessment or individual legal advice. Byte identity applies to the current Office for Seniors PDF on 9 October 2026, not all official formats or future law. Use current primary guidance and a qualified authorised witness for setup.

A blank form package is not an executed EPA, a capacity assessment or an individual legal-compliance finding.

## Primary sources and research provenance

- [Office for Seniors: creating an EPA](https://www.officeforseniors.govt.nz/our-work/promoting-enduring-power-of-attorney/how-to-create-an-enduring-power-of-attorney)
- [Office for Seniors: resources and publication-month labels](https://www.officeforseniors.govt.nz/resources-publications?action_doDocumentSearch=Apply&enduring-power-of-attorney-7=1)
- [Office for Seniors: when an EPA comes into effect](https://www.officeforseniors.govt.nz/our-work/promoting-enduring-power-of-attorney/when-an-epa-comes-into-effect)
- [Justice: EPA forms and court review](https://www.justice.govt.nz/family/powers-to-make-decisions/the-court-and-enduring-power-of-attorney-epa/)
- [MSD: 16 March 2017 reform announcement](https://www.msd.govt.nz/about-msd-and-our-work/newsroom/media-releases/2017/new-forms-for-creating-enduring-powers-of-attorney-released.html)
- [Official regulations version 30 January 2021](https://legislation.govt.nz/secondary-legislation/pco-drafted/2008/310/en/2021-01-30.pdf)

Repository research fixture `artifacts/research/epa-originals-and-current-primary-sources-2026-10-09.json` records preserved originals, hashes, full page evidence, exact current downloads, wording comparisons and date limitations.