Living will (Basic)

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To my family and physician:

This declaration is made by me

Name*

Identity Number:*

Residential Address:*

If the time comes when I can no longer take part in decisions for my own future, let this declaration stand as the testament to my wishes.

If there is no reasonable prospect of my recovery from physical illness or impairment in which I am suffering continual pain or am incapable of ever again living a rational existence and when I am no longer capable of being consulted regarding my wishes, I request that I be allowed to die with dignity and not be kept alive by artificial means.

I request that they administer whatever drugs necessary to keep me comfortable during this period even if it may reduce the length of my life and that I not be given tube feeding.

Signed by me at

Place

Date

in the presence of the undersigned witnesses, all of us being present at the same time.

Witness 1:

Full name of witness 1

Telephone number

Address

Street Address Address Line 2 City Province Postal Code

Signature

Witness 2:

Full name of witness 2

Telephone number

Address

Street Address Address Line 2 City Province Postal Code

Signature

Contact Details

Tel: 021 824 2024
Email : info@ajslaw.co.za
Address:
22B Church Street, Durbanville, Cape Town, 7550

Postal Address:
PO Box 4700, Durbanville, 7551
Docex: 3 Durbanville

Company Registration Number 2019/017663/21