File Number

	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

AFFIDAVIT FOR A PERSON TO ACT AS LITIGATION GUARDIAN

		Applicant

 		Respondent

On ___________________________________
                                  (date) 

I _________________________________________________________________________   
(full name of person making the affidavit)

Of________________________________________________________________________ 
(home or business address or place of employment),

*[say on oath/ solemnly affirm]-

1.	I make this affidavit as (state capacity in which person makes the affidavit)

2.	(Name), of (address), has agreed to be the litigation guardian of the *respondent/applicant]

3.	(Name) is an appropriate person to be a litigation guardian.

4.	(Name) has no interest in proceeding adverse to the interest of the *[respondent/applicant]

*[Sworn/Affirmed] by _________________________________________________________ 
(full name)

__________________________________________________________________________
(signature of person making the affidavit)

At________________________________________________________________________ 
(place)

in the presence of:
__________________________________________________________________________
(signature of person before whom affidavit is made)

__________________________________________________________________________
(Full name of person before whom affidavit is made) 
of __________________________________________________________________________
				(Address)

*[Justice of the Peace/Barrister/Solicitor/(other)]

*omit if, or whichever is inapplicable