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Person 2 - Full name
Address
Home telephone
Mobile telephone
BOX EIGHT – STATEMENTS AND SIGNATURE
STATEMENTS
I am aged over 18.
The decisions set out in this Living Will apply even if my life is at risk as a result and I give the instructions in this Living Will –
even if I may as a result be refusing treatment necessary to sustain my life, and
even if the resulting treatment or non-provision of treatment might precipitate my death.
This Living Will remains in force until I have made it clear that it has been revoked or amended.
I have read and understood the explanatory notes annexed to this document.
EXECUTION AND DATE
IN WITNESS of which this Living Will was signed and delivered as a deed on 2017
278 Appendix E
