AFOVA New Letter 2 of Year 2021

Section 7 – Panorama CV 2 No. 02 / 2021 Page 314 of 332 I request that this ‘declaration’ should be honoured by my family members and physicians as the final expression of my legal right to refuse medical or surgical treatment accepting the consequences of such refusal. This document may be informed to my regular physician. To secure compliance with this declaration, to make medical decisions as may be required from time to time on my behalf, I hereby appoint the following as my Health Care Power-of-Attorney. S/he/they have expressed acceptance of this responsibility. I hereby vest in my attorney the power to obtain medical information, make decisions and act on my behalf regarding wishes expressed in this ‘declaration’ , notwithstanding any contrary views held by any other person. 1. Name ............................................................Signature.............................. Date of Birth ……………… Aadhaar.............……………............................ Phone……………………Email …..…………………………….......................... Address .……................................................................................................ If this person is not available, the next two persons may be approached in the same order. 2. Name...........................................................Signature............................ Date of Birth ……………… Aadhaar.............……………............................ Phone……………………Email…..……………………………............. Address ……............................................................................................