We, the undersigned Jurats of the Royal Court of Jersey, duly appointed by Act of the Royal Court to investigate an application by……………………………..……………(insert Curator’s full name), Curator of………………………………………………..………………..(insert Interdict’s full name) under Article 43 (17) of the Mental Health (Jersey) Law, 1969, being satisfied that the proposed action of the Curator is necessary or expedient, hereby consent as follows:-

(here give details of the action which was proposed in the Representation in brief)

Dated this………day of ………………20…

Signed:

……………………………………………………………………………….………..Jurat

…………………………………………………………………………….…….…….Jurat