[Trust Family Bulletin] Health Documentas - Living Will

[Trust Family Bulletin]

APPOINTMENT OF REPRESENTATIVE AND LIVING WILL

(Applicable in India Only)


In the event that I become unsound in mind or body, or that I am unable 
to handle my personal, financial and medical affairs, or that I am 
unable to make such decisions for any reason whatsoever, I am desirous 
of appointing a fit and able person to act for me as my official 
representative in India. I am executing this document voluntarily and 
without coercion. I fully understand the implications therein.

I have requested _________________________, aged ____ years, having a 
permanent address of: _____________________________________________________,

to act for me. In the event that __________________________ is unable to 
serve as my representative, I appoint _________________________, aged 
____ years, having a permanent address of: 
_____________________________________________________,

as my official representative to act for me.


My representative shall do the following:

Look after all my financial and medical affairs in India.
Pay all bills, charges, and outgoings on my behalf, manage my bank 
accounts, etc, and receive any income from the same, and demand or issue 
valid receipts for any such amounts paid or received on my behalf. My 
representative shall not be held financially responsible for any of my 
debts or financial liabilities.
Sign consent terms on my behalf regarding financial and medical 
decisions and actions.
Ensure that my wishes about my healthcare are followed if I am unable to 
communicate them. This includes the following choices: (check off your 
choice and initial under (a.) and (b.) and write in any other wishes 
under (c.).
I want to be _____ /I do not want to be______/ kept alive artificially 
if I am terminally ill with a disease or condition from which I have no 
reasonable chance of recovering or quality of life.
I want to be _______/ I do not want to be_______ /revived should I start 
to die under the conditions stated above.
Other wishes :_____________________________________________________
_________________________________________________________________

My representative generally shall do all other activities, deeds and 
things in respect to my personal property, finances and medical matters 
which may seem necessary, and all such acts, deeds and things done by my 
representative shall be deemed as acts, deeds and things done by me.


In witness whereof, I have signed this living will and appointment of my 
representative on this _____ day of ______________, in the year _____.

____________________________

Signature

Place _____________________





Witnesses: (Print and Sign)

1)

2)

Representatives: (Print name and sign in acceptance). Address

1)


2)



(This form is mandatory for healthcare purposes. It may be edited to fit 
your own wishes and needs. It should be completed except for the 
signatures, and then, sent to Craig Ruff at Avatar Meher Baba Trust, 
Ahmednagar. The form will be copied onto stamp paper at the Trust and 
then returned for notarization with yourself, your representatives, and 
witnesses appearing for signing. It must be accompanied by a doctor’s 
letter certifying that you are in sound mind and body. Witnesses to your 
signature must be impartial to your interests. They can be anyone 
present at the time of signing. Thus, your wife or husband may not serve 
as a witness because they most likely will be your choice as 
representative. The notarized copy of the form should then be given to 
Craig Ruff at the Trust Office, Ahmednagar, and a certified copy, 
provided by the notary, to Dr. Anne at Meher Hospital. Please note that 
you may change the choices made in this document at any time. It will be 
up to you to update it as needed.)