What is this sample, and what is it not?
Under Article 103 of the Civil Code, a transaction may also be concluded through a representative, and under Article 107 authority is granted by a declaration of will. The Code does not prescribe a special form for every power of attorney, but in practice banks, clinics and public bodies ask for a notarised document, because only then is it confirmed that the principal really signed it.
That is why the text below is a draft, not a finished document. Its purpose is to let you arrive at the notary with a list already thought through, so that one visit is enough. The notary drafts the text to their own standard and may change the wording or remove an unnecessary clause. The notary checks the identity and legal capacity of the parties, and without a signature and the notarial certificate the sheet has no legal force.
When does a family need such a power of attorney, and where is it presented?
In medical matters, a power of attorney becomes necessary at the moment the patient can no longer get to the institutions themselves, while bills, contracts and paperwork will not wait. Typical situations are:
- the patient is in hospital or being treated abroad, and a family member in Georgia has to pay the clinic's bills and sign annexes to the contract;
- the money for treatment is in the patient's bank account, and someone else must be able to transfer it to the clinic;
- a relative is putting together the funding application: signing the application, submitting the documents and receiving the reply, as described in the Referral Services Programme guide;
- copies of the medical records are needed for a second opinion or for a foreign clinic;
- a reimbursement claim or a written complaint to an insurance company has to be filed in the patient's name.
The document is presented to the clinic's administration, a bank branch, the National Health Agency, City Hall or an insurance company. If the power of attorney has to work abroad, it needs an apostille and a translation into the language of the destination country; this stage is explained on the apostille and legal document translation pages.
What does the notary need?
The notary establishes the identity of the parties from an identity document and, before performing the notarial act, checks whether the principal understands what they are signing. Before the visit, prepare:
- The principal's valid ID card or passport. The act will not be performed with an expired document, so check the date in advance.
- The representative's exact details: first name, surname, personal number, date of birth and address, and for a foreign national the passport number in Latin spelling. Their attendance is not required; a copy of their document is enough.
- Details of the institutions and accounts: the full name of the clinic, the bank and account number, the insurance policy number. The more precise the details, the fewer questions the receiving party will have.
- The institution's requirements, if the bank or clinic has given you its own text or wording.
- The completed draft of this sample, sent by email in advance so that the notary can prepare the text before the visit.
If the principal cannot sign because of illness or physical condition, the instruction on notarial acts allows another person present at the act to sign at the principal's request and on their behalf. This happens in the presence of the notary, not at home without the notary. When the patient cannot get to the office or is outside the country, the options are compared on the remote power of attorney page.
Which powers should you include for each institution?
It is best to build the text in blocks: each block concerns one institution or one purpose and contains only the actions you will actually need. The table shows what is usually included and where care is needed.
| Block | Actions included | Care needed |
|---|---|---|
| Clinic | Signing the contract, its annexes and the cost estimate, paying for services, receiving financial documents | Name a specific clinic or a defined group of institutions; a general “any organisation” is vague |
| Medical information | Receiving information on the state of health, requesting copies of records, the discharge summary and test results | The patient's explicit consent to the release of confidential information should be written in directly |
| Bank | Cash withdrawal, transfers for treatment costs, obtaining statements | One bank, one or several accounts, preferably with a maximum amount |
| Public bodies and programmes | Submitting an application, handing in documents, receiving the decision, filing an administrative complaint | Name the agency, ministry or City Hall, if known in advance |
| Insurance | Filing a reimbursement claim and a complaint, receiving the reply and case materials | Policy number; decide separately on the right to receive money |
The medical information block is particularly important. Under Article 21 of the Law on Patient Rights, a patient with legal capacity decides whether anyone may receive information about their health, and Article 28 allows confidential information to be released with the patient's consent. The right to request copies of records is set out in Article 17, and the practical route is in the guide to obtaining your medical records.
What does not go into a medical power of attorney
Consenting to or refusing treatment is the patient's personal decision, and a general clause in a power of attorney cannot replace it. Article 24 of the same law gives the patient the option of naming in advance, in writing, a person who will make decisions on medical care if the patient is no longer conscious or cannot make the decision. This is a separate declaration of wishes, formalised with the involvement of the treating doctor. Nor is it advisable to mix the sale of property or taking out a loan into a medical power of attorney: such actions need a separate, strictly limited document.
Validity, sub-delegation and revocation: what should you decide in advance?
Under Article 109 of the Civil Code, authority ends when its term expires, when the representative refuses it, when the principal revokes it, when the mandate is completed or when the principal dies, and also when the principal is designated a recipient of support and needs a representative in that area. Three practical conclusions follow:
- Validity: match it to the real treatment plan. If surgery and rehabilitation take four months, a five-year power of attorney is an unjustified risk, while a two-week one will run out halfway.
- Sub-delegation: either allow it or prohibit it unambiguously. Under the notarial instruction, a power of attorney issued by way of sub-delegation cannot be valid for longer than the original authority.
- Revocation must be communicated to third parties. Under Article 108, revocation or amendment of authority is communicated to the third parties with whom the representative dealt; otherwise it may have no effect against them. Under Article 110, the representative must return the document of authority to the principal.
People often forget that a power of attorney ends on death: from that moment the account can no longer be operated under the power of attorney, and the matter is settled through inheritance. This is covered on the wills and inheritance page.
Sample power of attorney: a working draft for the notary
Copy the text, fill in the fields in square brackets, delete the blocks you do not need and send the draft to the notary in advance. Do not sign this text at home. The power of attorney itself is drawn up in Georgian: the Georgian version of this page (language switch at the top) has the original text to send to the notary.
Power of attorney (draft for the notary; the final text is drawn up by the notary)
[City], [Date]
I, [Principal's first name and surname], born [Date of birth], personal number [Personal number], residing at [Address], by this power of attorney appoint [Representative's first name and surname], born [Date of birth], personal number [Personal number or passport number], residing at [Address] (hereinafter: the Representative), and authorise the Representative, in my name and in my interests, to perform the following actions:
1. Dealings with the medical institution. At [Full name of the clinic or group of institutions]: to sign the contract for medical services, its annexes and the cost estimate; to pay for the services; to receive invoices, receipts and acceptance certificates.
2. Medical information and documents. To receive information about my state of health; to request and receive copies of my medical records, Form IV-100/a, the discharge summary, and laboratory and instrumental examination results. For this purpose I consent to [Name of the clinic or “any medical institution”] releasing confidential medical information about me to the Representative.
3. Banking operations. At [Name of the bank], in respect of my account [Account number]: to withdraw cash and to make transfers, including abroad, to cover treatment and related costs, up to a total of [Maximum amount and currency]; to obtain account statements.
4. State and municipal programmes. To submit in my name an application and documents to [Name of the body] for the purpose of funding treatment; to receive the decision and, where necessary, to file an administrative complaint.
5. Insurance company. At [Name of the insurer], policy [Policy number]: to file a reimbursement claim and a complaint, and to receive replies and case materials. Receipt of insurance payments: [“permitted to the Representative's account” or “to my account only”].
To perform the actions listed above, the Representative may sign applications, pay fees and obtain the certificates required for this purpose.
Restrictions. This power of attorney does not authorise the Representative to dispose of or encumber my property, to take out a loan in my name, or to make a decision on medical intervention on my behalf.
Sub-delegation: [prohibited or permitted].
Period of validity: [Date until which it is valid].
The Representative shall keep documents evidencing expenses and, at my request, shall report to me on the actions performed.
I have read the text of this power of attorney; its content is clear to me and corresponds to my will.
Principal's signature: [Signed in the presence of the notary]
Notarial certificate: [Completed by the notary]
How to fill in the sample step by step
Choose the blocks
Keep only the parts you will genuinely need in the coming months. If you have no dealings with a bank, delete the third block entirely and renumber the rest.
Check the details against the documents
Copy names, personal numbers and addresses from the ID card, not from memory. A single wrong letter is enough for a bank to refuse to serve the representative.
Confirm the institution's requirements
Call the bank branch or the clinic's administration and ask whether they need specific wording. Put the answer you receive into the draft.
Choose the validity and sub-delegation
Write a specific date with a small margin as the end of validity, and in the sub-delegation field keep one of the options and delete the other.
Send it to the notary
Send the draft before the visit, so that the notary can rework the text to their own standard. Read the final version carefully before signing.
Which mistakes get a power of attorney rejected?
- The phrase “on all matters” instead of a list. The receiving employee looks for a specific verb, for example “to withdraw cash”, and if they cannot find it, they stop the transaction.
- A sheet signed at home. As a rule, a bank or public body will not accept a text signed without a notary, and someone else signing in place of the patient renders the document void.
- Leaving out the confidentiality consent. The clinic will hand over financial documents, but cannot release the discharge summary and diagnosis without the patient's explicit consent.
- Details that do not match foreign documents. If the power of attorney will be used abroad, the Latin spelling of names must match the passport; before ordering the translation, estimate the price and turnaround in advance with the Translation price calculator.
- Forgetting the end date. Once it expires, a new visit is needed, often at the most difficult moment.
Frequently asked questions about the sample power of attorney
Can I print this sample, sign it and take it to the bank?
No. This page offers a working draft intended for the notary, not a document for signing. In practice, banks and clinics ask for a notarised power of attorney, because only a notary confirms the identity of the principal and that they understood the text and signed of their own free will. A sheet signed at home gives no such guarantee. Send the draft to the notary in advance; they will transfer the text into their own form, and once it is notarised you can present the document to any institution.
Can a relative consent to an operation on my behalf under a power of attorney?
Consent to a medical intervention is the patient's personal decision, and this sample deliberately lists it as a restriction. Article 24 of the Law on Patient Rights provides a separate option: the patient may name in advance, in writing, a person who will make decisions on medical care if the patient is no longer conscious or cannot make the decision. This is formalised with the involvement of the treating doctor. Treatment decisions themselves are always made together with the treating doctor, and neither a sample nor a lawyer can replace that.
How long does a power of attorney made from this template stay valid?
For as long as you state in the text, or until another ground under Article 109 of the Civil Code arises: completion of the mandate, revocation, the representative's refusal or the principal's death. So state a specific date as the end of validity, one that covers the treatment plan with a small margin. If treatment is extended, a new power of attorney is safer than a validity of several years from the outset. Some banks run extra checks on an older power of attorney, so if in doubt, contact the branch in advance and ask how old a document they accept.
How do I revoke a power of attorney if I no longer trust the person?
The principal can revoke a power of attorney at any time, usually at a notary. What matters is what happens next: under Article 108 of the Civil Code, the revocation must be communicated to the third parties with whom the representative dealt, that is, the bank, the clinic or the insurance company. If they did not know and should not have known, the revocation may not take effect against them. In addition, under Article 110 the representative is obliged to return the document of authority to the principal. Send the notifications in writing and keep copies.
Will a Georgian power of attorney work for treatment abroad?
It can, if you prepare it correctly. For use in a country that is party to the Apostille Convention, a Georgian notarial act needs an apostille; in other countries it needs consular legalisation. On top of that comes a translation into the language the foreign clinic or bank requires. To save time, a bilingual text is often prepared, which the notary certifies in one go. The “Apostille or legalisation?” tool shows you which route you need; always ask the foreign institution about its specific requirements in advance.
Sources and official pages
- Civil Code of Georgia (Articles 103, 107-110, representation and power of attorney): matsne.gov.ge/ka/document/view/31702 (accessed 2026-10-12)
- Law on Patient Rights (Articles 17, 21, 24, 28): matsne.gov.ge/ka/document/view/16978 (accessed 2026-10-12)
- Order No. 71 of the Minister of Justice, Instruction on the procedure for performing notarial acts: matsne.gov.ge/ka/document/view/1010061 (accessed 2026-10-12)