File Number

	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

CONSENT AND UNDERTAKING BY PERSON TO ACT AS LITIGATION GUARDIAN

Applicant

Respondent

Consent

I, ________________________ of ______________________________________________                   
                (Name)                                                   (Address)

consent to be the litigation guardian of *[applicant/respondent] ________________________  
                                                                                                                    (Name).

*Undertaking
                      (complete this section if the person with a legal disability is an applicant)

I undertake to be liable for any costs that the applicant might otherwise be required to pay in the proceeding.

Signature:

Date

*omit if, or whichever is inapplicable