Lasting Power of Attorney Instruction Form

Documents Required

Property and Financial Affairs LPA
Health and Welfare LPA

Your Title and Full Name

Date of Birth

Address

Telephone Number

Email

Any other names you are known by (e.g. maiden name or professional names)

Attorney's title and full name (including middle name), address, date of birth, occupation and contact details including any e-mail address and mobile number.

Please note that if you appoint more than one Attorney you can appoint them to act either jointly or severally. In practical terms it is not sensible to have more than four Attorneys and they should be based in the UK and be able and willing to act. The Attorneys must be over the age of 18 and must not be bankrupt or be the subject of any criminal convictions. The Attorneys have extensive powers and it is essential therefore that you only appoint those people that you can absolutely trust and reply on to carry out your instructions and wishes particularly if you were to lose mental capacity.

How many Attorney's do you wish to appoint?

1
2
3
4

Attorney 1

Title

Full Name

Date of Birth

Address

Occupation

Telephone Number

Email

Relationship to Donor

Attorney 2

Title

Full Name

Date of Birth

Address

Occupation

Telephone Number

Email

Relationship to Donor

Attorney 3

Title

Full Name

Date of Birth

Address

Occupation

Telephone Number

Email

Relationship to Donor

Attorney 4

Title

Full Name

Date of Birth

Address

Occupation

Telephone Number

Email

Relationship to Donor

How do you wish your attorneys to act?

Please tick one of the following boxes*

I have only appointed one Attorney
Jointly (Attorneys must agree unanimously on every decision, however big or small. This means simply decisions could be delayed because it takes time for the Attorneys to get together. If one Attorney dies or can no longer act, none of your Attorneys can act. If your Attorneys can’t agree a decision, then they would have to go to court. )
Jointly and Severally (This is the most practicable option as your Attorneys can make decision on their own or together. They can get together to make important decisions if they wish, but can make simple or urgent decisions on their own. It’s up to the Attorneys to choose when they act together or alone. It also means that if one of the Attorneys dies or can no longer act, the others can continue to act.)
Joint for some decisions, jointly and severally for other decisions (Your Attorneys must agree unanimously on some decisions, but can make others on their own. If you choose this option, you must list the decision your Attorney should make jointly and agree unanimously on. If one Attorney dies or can no longer act, none of your Attorneys will be able to make any of the decisions you have listed to be made jointly)

When do you want your attorney's to be able to make decisions?

Please tick one of the following boxes*

As soon as my LPA has been registered (While you still have mental capacity, your Attorneys can only act with your consent. If you later lost capacity, they can continue to act on your behalf for all decisions covered by this LPA.
This option is useful if you are able to make your own decisions but want your Attorneys to help you – for example, if you’re away on holiday, or if it is physically difficult for you to visit the bank, talk on the phone or sign documents.)
Only when I don't have mental capacity (This option can make your LPA a lot less useful. You Attorneys will not be able to use the LPA until after you have lost capacity. Your Attorneys may need to pay for an assessment and might be asked to prove you do not have mental capacity each time they try to use your LPA. )

Replacement Attorney

If you wish to have replacement Attorneys i.e. if something happens to your original Attorneys again please let us have details there (full name and address and again instructions as to whether to act jointly or jointly and severally)

Full Name

Date of Birth

Address

Occupation

Telephone Number

Email

Relationship to Donor

Are there any preferences you wish to put upon your Attorneys?

Most Powers of Attorney are general i.e. to manage all property and affairs but you could put a restriction on for instance stating that the Attorney has now power to change your Bank accounts for instance. If there any such restrictions you would like please list them here.

Are there any instructions you wish to give to the Attorney?

Instructions might include instructions as to charitable donations or gifts to family members on birthdays and Christmas or how you wish your money to be invested.If you appoint professional Attorneys you must indicate how they will be paid for their services.

People to be notified

The previous system required a person to be notified when the Power of Attorney is registered. The Power of Attorney is only effective when it is registered with the Public Guardianship Office. Under the new system up to five family or friends can be notified as a protection to you in case the Attorney is acting against your wishes and they are then able to object on your behalf. However, you are not required to name anyone if you do not wish to do so.If you do not wish to appoint a person to be notified, we need their full names and addresses including telephone numbers and any email address. You will also need to ensure for the future that this list is kept up to date with any address changes.

Person 1 Name

Person 1 Address

Person 1 Telephone

Person 1 Email

Person 2 Name

Person 2 Address

Person 2 Telephone

Person 2 Email

Thank You

THANK YOU FOR COMPLETING THIS FORM. WE WILL BE IN TOUCH SHORTLY.

Form Completed By

Date

Lasting Power of Attorney Questionnaire

Attorney 1

Attorney 2

Attorney 3

Attorney 4

How do you wish your attorneys to act?

When do you want your attorney's to be able to make decisions?

Replacement Attorney

People to be notified

Thank You

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