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Lasting Power of Attorney Questionnaire

Lasting Power of Attorney Questionnaire

Fields marked (required) must be completed.

1. Your Details
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2. Your Husband/Wife/Civil Partner
3. Your Children

Child 1

Child 2

4. Your Primary Attorneys

You should think carefully about who you like to act as your attorneys. Please read the separate guidance about choosing your attorneys before completing the form.

Attorney 1

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Attorney 2

5. Your Replacement Attorney
6. Type of Lasting Power of Attorney

Please read the guidance note about the two different types of LPA – Health and Welfare and Property and Financial Affairs. Do you if you want to create one or both?

(required)
7. Person to Be Notified

This is a safe-guarding procedure and at least one person must be told that you are registered the LPAs. The person will receive a notice and they do not need to take any action unless they feel the need to object. Please provide at least one name of a friend or family member to be notified.

(required)
8. Certificate Provider

This is another safe-guarding procedure. You need to name at least one person to act as a “certificate provider”. The person you choose must be independent from you and your Attorneys. They must sign the form to certify that you understand the form and have not bee unduly influenced. A solicitor can sign or you may choose a close personal friend.

9. Guidance, Restrictions and Miscellaneous
10. Queries and additional information