Name of Incapable Person (in full): ____________________________________________________________
(Surname, first and initials)
Address: __________________________________________________________________________________
__________________________________________________________________________________
Telephone: Residence_________________________________ Date of Birth: ___________________________ (Day, Month, Year)
Your relationship to the incapable person is:
1. spouse * 2. partner ** 3. relative ________________________________ (describe relation)
Or, you are a:
4. trust corporation
5. attorney under a continuing power of attorney made prior to the date the Certificate of Incapacity was issued and which does not give the attorney authority over all of the incapable person's property
Attachment( s) required:
if box 4 above is completed, copy of the consent of the incapable person's spouse or partner
if box 5 above is completed, copy of continuing power of attorney
*'Spouse' means a person of the opposite sex, (a) to whom the person is married, or
(b) with whom a person is living in a conjugal relationship outside marriage, if the two persons:
(i) have cohabited for at least one year, (ii) are together the parents of a child, or
(iii) have together entered into a cohabitation agreement under Section 53 of the Family Law Act.
** Two persons are 'partners' if they have lived together for at least one year and have a close personal relationship that is of primary importance in both persons' lives.
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SUBSTITUTE DECISIONS ACT, 1992 Form 1
Form No. 236 2 of 4
Please list any other person who is entitled to apply under subsection 17( 1) *** who is known to you. Please state whether you have informed each person listed on your application for statutory guardianship and
indicate if they have informed you of whether they support or oppose your appointment.
*** Any of the following persons may apply to the Public Guardian and Trustee to replace the Public Guardian and Trustee as an incapable person's statutory guardian of property:
(i) the incapable person's spouse or partner, (ii) a relative of the incapable person,
(iii) the incapable person's attorney under a continuing power of attorney, if the power of attorney was made before the Certificate of Incapacity was issued and does not give
the attorney authority over all of the incapable person's property, or (iv) a trust corporation within the meaning of the Loan and Trust Corporations Act, if the
incapable person's spouse or partner consents in writing to the application.
Name Person( s) Informed
Yes/ No
Relationship to
Incapable Person
Address and Telephone Number Support or Oppose Application
Applicant's Statement:
1. Have you been in personal contact with the incapable person during the preceding 12-month period?
Or, if you are a trust corporation, has the incapable person's spouse or partner been in personal contact with the incapable person during the preceding 12-month period?
Yes No
2. Are you willing to perform all duties required of a guardian in respect of the incapable person's property and do you agree to act in accordance with the Management Plan?
Yes No
3. To the best of my knowledge and belief, the total approximate value of the property of the incapable person is $______________. Particulars of the assets and their respective approximate value are listed on the attached
Management Plan, forming part of this application. (If you are a trust corporation, please skip questions 4-8)
4. Is your relationship with the incapable person a friendly one?
Yes No
5. Have you been found guilty of any offence relating to financial mismanagement under the Criminal Code?
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SUBSTITUTE DECISIONS ACT, 1992 Form 1
Form No. 236 3 of 4
Yes No
6. Are you an undischarged bankrupt?
Yes No
7. Have you been held liable in a civil proceeding relating to fraud, breach of trust or any other type of financial mismanagement?
Yes No
8. I understand that the Public Guardian and Trustee may refuse my application unless I provide a bond securing the value of the incapable person's property in a form and amount agreeable to the Public Guardian and
Trustee of Ontario.
Yes No
NOTE: Attach Management Plan
SUBSECTIONS 89( 5) and (6) OF THE SUBSTITUTE DECISIONS ACT, 1992 PROVIDE:
ss. 89 (5): NO PERSON SHALL, IN A STATEMENT MADE IN A PRESCRIBED FORM, ASSERT SOMETHING THAT HE OR SHE KNOWS TO BE UNTRUE OR PROFESS AN OPINION
THAT HE OR SHE DOES NOT HOLD.
ss. 89 (6): A PERSON WHO CONTRAVENES SUBSECTION (5) IS GUILTY OF AN OFFENCE AND IS LIABLE, ON CONVICTION, TO A FINE NOT EXCEEDING $10,000.00
_____________________ _________________________________________________________________________________________ Date Signature of proposed Statutory Guardian( s) of Property or,
if a trust corporation an authorized signing officer
Name (s): ___________________________________________________________________________________ (Please Print)
___________________________________________________________________________________
Address (es): _________________________________________________________________________________ _________________________________________________________________________________
_________________________________________________________________________________ Telephone number( s): _________________________________________________________________________
NOTE: If you are proposing the appointment of two or more persons as joint statutory guardians, please indicate to which applicant the property and accounts, if applicable, and the Certificate of Statutory Guardianship
should be delivered if the appointment is made:
Name of proposed statutory guardian of property: ___________________________________________________
Address: __________________________________________________________________________________ __________________________________________________________________________________
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SUBSTITUTE DECISIONS ACT, 1992 Form 1
Form No. 236 4 of 4
Telephone: __________________________________________________________________________________
Notice to the Applicants:
1. The personal information contained in your application is collected under the authority of section 17 of the Substitute Decisions Act, 1992, and will be used to process your application to replace the Public
Guardian and Trustee as statutory guardian of property in accordance with the law and policies of the Office of the Public Guardian and Trustee. Questions about this collection of information should be
directed to:
Office of the Public Guardian and Trustee 595 Bay Street, Suite 800
Toronto, Ontario, M5G 2M6 Tel: (416) 314-2800
Attention: Screening Unit
Notice of Fee
The Public Guardian and Trustee charges a fee of $382.00 plus GST of $19.10 for processing an application for statutory guardianship, under the
authority of s. 8 of the Public Guardian and Trustee Act. This fee will be collected from the incapable person's property at the time the application
process is completed or, if insufficient funds are held by the Public Guardian and Trustee, will be payable by the applicant prior to assuance of the certifi-
cate of statutory guardianship. In cases where payment of the fee will cause undue financial hardship to the incapable person, it is possible to obtain a
waiver of the fee.
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