Both Types of Lasting Power of Attorney – Single – Remi Aiyela

Title, First name, Middle name(s), Last name *

Date of birth *

Full residential address, including post code and country. *

Email *

Phone number(s) including code *

Mobile number preferred

Attorney 1: Title, First name, Middle name(s), Surname and Date of birth *

*You can have any number of attorneys. Use the Anything Else box to add more attorneys if you want more than 2. Consider making some attorneys replacement attorneys if you have too many. You can also have just 1 attorney.

Attorney 2: Title, First name, Middle name(s), Surname and Date of birth

Replacement attorney 1: Title, First name, Middle name(s), Surname and Date of birth

*This is optional but advisable if you have only 1 attorney.

Replacement attorney 2: Title, First name, Middle name(s), Surname and Date of birth

*This is optional but advisable if you have only 1 attorney.

Do you want different attorneys for your Health and Welfare LPA? *

If NO (if you want different attorneys) you MUST provide attorney separate details (title, full name, address, date of birth) in the Anything Else box below. Please make sure to say it is for Health and Welfare attorneys.

How do you want your attorneys to make decisions? *

Jointly
Jointly and severally
Jointly for some and jointly and severally for others

*Only relevant if you appointed more than one attorney. *Jointly means the attorneys must act unanimously. *Jointly and severally means that any of the attorneys is able to act for you. *If you choose jointly for some then you will have to list the decisions your attorneys need to act jointly on.

When can your attorney make decisions for you? *

As soon as the LPA is registered
Only when I lose mental capacity

Only relevant for Property and Financial Affairs LPA. The Health and Welfare LPA can only be used after you lose the mental capacity to make your own decisions.

Life sustaining treatment: can your attorney(s) give or refuse consent to life-sustaining treatment on your behalf? *

Yes means you give your attorneys authority to give or refuse consent to life-sustaining treatment on your behalf. No means that you do not give them the authority.

Person to be notified 1: Title, First name, Middle name(s), Surname, Date of Birth

*It is useful to have someone to be notified as a protective measure when the LPA is registered. You can have any number of people to be notified. Use the Anything Else box to add more people.

Person to be notified 2: Title, First name, Middle name(s), Surname, Date of Birth

Preferences for Property and Financial Affairs

This section allows you to tell your attorneys how you would like them to make their decisions.

Preferences for Health and Welfare

This section allows you to tell your attorneys how you would like them to make their decisions.

Instructions for Property and Financial Affairs

This section allows you to tell your attorneys how you how they should make certain decisions. If none, write N/A.

Instructions for Health and Welfare

This section allows you to tell your attorneys how you how they should make certain decisions. If none, write N/A.

Certificate Provider - Title, First name, Middle name(s), Surname, Date of Birth

*Someone must sign as a ‘certificate provider’ to confirm that they have discussed the LPA with you and that you understand what you are doing and that nobody is forcing you to do it. This can be someone who has known you personally for at least 2 years, such as a friend etc, or it can be someone with relevant professional skills such as your solicitor

Anything else you would like us to know?

Let us know if there is any other relevant information we should know.

You confirm that you: *

Are over the age of 18 years
Under no constraint or undue influence
Give these instructions freely and voluntarily