LPA Data collection form

By completing this form you agree that the information can be passed to relevant 3rd parties these are only the Office of the Public Guardian for Lasting Powers of Attorneys or our associated solicitors / barristers should freestanding trust be required. We do not pass your information on to any other 3rd parties. We do not sell your information and all information is deleted once the application has been completed.Our ICO Information Commissioners Office Registration Licence No. Is ZA149282*

YesNo

Please contact us to discuss your requirements

All sections with a * need to be answered if you see a warning “this field is required” this relates to ALL THE FIELDS in this question NOT just the one the warning appears to be pointing to. Example in address the arrow may appear to point to post code it actually means that a element in the whole address is missing highlighted in with a red box.*

I understandI don't understand

Where Names are asked for please provide a FULL Official name as it would appear on a Passport, Inland Revenue, or Social Security documents. Irrespective of whether the full name is used on a day-to-day basis. This is also relevant to people you may want as Attorneys, Certificate Providers. If their Official proof of identity ie. passport is different from the name listed in the Will the appointment will be invalid.*

I understand

Do you require Tick ALL that apply*

Property & Financial AffairsHealth & WelfareBusiness Property & FinanceOther

Do you own or control any business that would be affected? Should you no longer be able to act as a director or person with authority? Tick All that are relevant.*

Not ApplicableDirector of Private Limited Company.Signatory or Co-signatory of business bank accounts.Owner or Leaseholder of any business premises.Signatory to any other contracts.Other

Donor = the person who the LPA applies to.

Attorney = The trusted person who the Donor wants to handle their affairs

Replacenent Attorney = reserve person

Certificate Provider = A person that the Donor has know for over 3 years who has regular contact and can testify to their mental state.

People to Notify = (not allways needed) these are people who you wish to notify that your affairs are now being handeled by your Attorney.

Business Attorney = The trusted person who the Donor wants to handle their business affairs.

All Names should be as on a Passport or HMRC documentation.Irrespective to whether they are in general usage.

If you are completing this form on behalf of someone else REMEMBER to answer as the Donor.

Donor's Full Name*

PrefixFirst NameMiddle NameLast Name

Are you known by another name?

Date of Birth*

DD/MM/YYYY

Marital Status*

Gender*

MaleFemale

Are you registered blind?*

YesNo

Do you have mental competency*

YesNo

If NO then a LPA will not be granted.

However it is posible to set up a "Deputyship" which can be granted by a court to a person who has lost mental capacity.

We can assist with this.

Have you a current and valid Will.*

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

Phone Number*

Area CodePhone Number

Best time to call

This is only if we have a query.

Jointly and severally
Attorneys can make decisions on their own or together. Most people
choose this option because it’s the most practical. Attorneys 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, your LPA will still work.
If one attorney makes a decision, it has the same effect as if all the
attorneys made that decision.
Jointly
Attorneys must agree unanimously on every decision, however big or
small. Remember, some simple decisions could be delayed because it
takes time to get the attorneys together. If your attorneys can’t agree a
decision, then they can only make that decision by going to court.
Be careful – if one attorney dies or can no longer act, all your attorneys
become unable to act. This is because the law says a group appointed
‘jointly’ is a single unit. Your LPA will stop working unless you appoint at
least one replacement attorney.

Jointly for some decisions, jointly and severally for other decisions
Attorneys must agree unanimously on some decisions, but can make
others on their own. If you choose this option, you must list the
decisions your attorneys should make jointly and agree unanimously
on Continuation sheet 2. The wording you use is important.
Be careful – if one attorney dies or can no longer act, none of your
attorneys will be able to make any of the decisions you’ve said should be
made jointly. Your LPA will stop working for those decisions unless you
appoint at least one replacement attorney . Your original
attorneys will still be able to make any of the other decisions alongside
your replacement attorneys.

How do you want your attorneys to work together?

Jointly and severallyJointlyJointly for some decisions, jointly and severally for other decisions

list the decisions your attorneys should make jointly and agree unanimously The wording you use is important.

Who do you want to make decisions about life-sustaining treatment?*

Option A – I give my attorneys authorityOption B – I do not give my attorneys authority

Option A – I give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf.
If you choose this option, your attorneys can speak to doctors on your behalf as if they were you.

Option B – I do not give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf. If you choose this option, your doctors will take into account the views of the attorneys and of people
who are interested in your welfare as well as any written statement you may have made, where it is practical and appropriate.

A lasting Power of Attorney is only in operation IF the Attorney are able to carry out your instructions.

Therefore consider the age of your choice, idealy they should be at least one gerneration younger that yourself. ( is a 90 year old the best choice for your atthorny when you are 95 years old)

Also consider the logistics firstly they need to be in the UK. Also near enought to you to be able to carry out there duties.

This LPA may not be needed (if at all for many years). It is prudent to have a reserve Athoney that is garanteed to be able to act on your behalf. It is posible to nominate a Profesional Atthoney as a reserve. We use Premier Solicitors who are specialist in probate, LPAs etc.

Who are

a Chartered Tax Adviser,
a Chartered Accountant,
a Notary Public,
a Taxation Technician,
a Financial Adviser,
a Chartered Secretary,
a Trust & Estate Practitioner.
So they can deal with the most complex of cases usually on a fix fee basis.

Premier Solicitors (Bedford) Ltd is registered in England & Wales, number 12495770.

Registered with the Chartered Institute of Taxation as a firm of Chartered Tax Advisors.

Premier Solicitors (Bedford) Ltd is authorised and regulated by the Solicitors' Regulation Authority (SRA) of England & Wales with SRA number 668813, and is bound by the rules found in the Solicitor’s Code of Conduct, a copy of which can be viewed at http://www.sra.org.uk/handbook/

Company address:
Premier Solicitors
Premier House, Lurke Street, Bedfordshire, MK40 3HU
Telephone: 01234 35 80 80
Fax: 01234 348112

Do you want to appoint Premier Solicitors as reserve Attorneys*

YesNoNot sure

Think about the logistics and practicality of having multiple Attorneys.

Example: Four attorneys living in different parts of the country having go get together to pay a utility bill.

Number of Attorneys ( It is not recommended to have more than 4)*

OneTwoThreeFour

Do you require DIFFERENT attorneys for your Health and Welfare P o A*

NoYes

A bankrupt person cannot act as a Attorney for a Property & Finance LPA. But they can act as Attorney in a Health & Welfare LPA.

This is a reason why having a professional reserve attorney is a useful option, you may not know your preferred attorney’s financial situation today, but you cannot know their situation in the future. With no eligible reserve your LPA can not be acted upon.

First Attorneys Full Name*

PrefixFirst NameMiddle NameLast Name

First Attorneys Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

First Attorneys Relationship to you.*

First Attorneys Date of Birth*

Date

Second Attorneys Full Name*

PrefixFirst NameMiddle NameLast Name

Second Attorneys Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Second Attorneys H&W Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Second Attorneys Relationship to you.*

Second Attorneys Date of Birth*

Date

Third Attorneys Full Name*

PrefixFirst NameMiddle NameLast Name

Third Attorneys Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Third Attorneys Date of Birth*

Date

Third Attorneys Relationship to you.*

Fourth Attorneys Full Name*

PrefixFirst NameMiddle NameLast Name

Fourth Attorneys Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Fourth Attorneys Date of Birth*

Date

Fourth Attorneys Relationship to you.*

Business Attorneys Full Name*

PrefixFirst NameMiddle NameLast Name

Business Attorneys Company Name (If accountants or other professional)

Business Attorneys Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

2nd Business Attorneys Full Name

PrefixFirst NameMiddle NameLast Name

Business Attorneys Company Name (If accountants or other professional)

2nd Business Attorneys Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List ALL business interest that you would want the Business Attorneys to manage.*

If you require additional features, we advise that you complete this form.

then one of our qualified advisers will call you and explain the options for you.

you may want to see our website www.saxonwills.co.uk where you will find videos and further information.

When do you want your attorneys to be able to make decisions?*

As soon as my LPA has been registered(and also when I don’t have mental capacity)Only when I don’t have mental capacityNot sure

As soon as my LPA has been registered
(and also when I don’t have mental capacity)
Most people choose this option because it is the most practical.
While you still have mental capacity, your attorneys can only act with
your consent. If you later lose 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
there’s another reason you want your attorneys to help you – for
example, if you’re away on holiday, or if you have a physical condition
that makes it difficult to visit the bank, talk on the phone or sign
documents.

Only when I don’t have mental capacity.
Be careful – this can make your LPA a lot less useful. Your attorneys
might be asked to prove you do not have mental capacity each time
they try to use this LPA.

Certificate Provider: This is someone who can confirm that you have mental capacity. This can either be a medical profesional or senior professional in a care home. There is usualy a charge for this.

Alternatively.

Any person over 18 who has know you for over two years (an has seen you regularly in that time). Who is not a attorney or reserve attorney or connect to a attorney ie spouce / partner / family member etc.

All they are confirming is that thay have mental capacity and are aware or what they are setting up,

Correspondence / Liaison*

DonorAttorney OneAttorney Two

People to notify when the LPA is registered*

YesNo

People to notify when the LPA is registered
This section is optional
You can let people know that you’re going to register your LPA. They can
raise any concerns they have about the LPA – for example, if there was any
pressure or fraud in making it.
When the LPA is registered, the person applying to register (you or one of
your attorneys) must send a notice to each ‘person to notify’.
You can’t put your attorneys or replacement attorneys here.
People to notify can object to the LPA, but only for certain reasons . After that, they are no longer involved in the LPA.
Choose people who care about your best interests and who would be willing
to speak up if they were concerned.

Notified Person Name*

PrefixFirst NameMiddle NameLast Name

Notified Person Relationship to you.*

Notified Person Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you want to appoint a reserve attorney*

NoYes

Reserve Attorney Name*

PrefixFirst NameMiddle NameLast Name

Reserve Attorney Relationship to you.*

Reserve Attorney Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Notes

Once we have recieced your instructions we will complete the forms for you. Then send these forms to you. You then have the forms signed.

Then you send the completed forms together with the registration fee to The Office of the Public Guardian

It takes up to 20 weeks to register an LPA.

During this time we cannot check on the appication.

It costs £82 to register each LPA unless you get a reduction or exemption.

This means it costs £164 to register both a property and financial affairs LPA and a health and welfare LPA.

You can apply for a reduction if you earn less than £12,000. You might also be able to apply for an exemption if you’re on certain benefits, such as Income Support.

Do you require a reduction or exemption form?

YesNONot sure, send the form anyway.Other

Do you require a GENERAL Power of Attorney

YesNoWould like more informationOther

A General Power of Atthorny can be put in place very quickly.

If you need to put a Power of Attorney in place quickly, We can proved a general power of Attorney. This can be useful if some is in hospital for example but needs a relative / friend to act on their behalf.

A General Power of Attorney can be put in place very quickly, as there is no registration process.

First Attorneys Full Name Health & Welfare *

PrefixFirst NameMiddle NameLast Name

First Attorneys H&W Relationship to you.*

First Attorneys H&W Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

First Attorneys H&W Date of Birth*

Date

Do you require a second Attorney for H & W*

YesNO

Second Attorneys Full Name Health & Welfare *

PrefixFirst NameMiddle NameLast Name

Second Attorneys H&W Relationship to you.*

Second Attorneys H&W Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Second Attorneys H&W Date of Birth*

Date

Price List LPAs

Single LPA£60.00

Either Health & Welfare or Property & Finance. Does not include Government registration.

Pair of LPAs£85.00

Either Health & Welfare or Property & Finance. Does not include Government registration.

Two Pair of LPAs£140.00

Both Health & Welfare and Property & Finance. Does not include Government registration.

Business Property & Finance£100.00

Property & Finance LPA for assets held in business names. Does not include government registration.

Two Single LPAs either H&W or P&F£100.00

Either Health & Welfare or Property & Finance. Does not include Government registration.

Total £0.00

If on a reduced income or some benefits, it may be possible to have a 50% reduction or pay NO fee.*

Does not apply to meWould like more information.

Exemption

If the donor receives any of the following means-tested benefits when an application to register is made, they can apply for an exemption, or their attorney or solicitor can do so on their behalf:

• Income Support

• Income-based Employment and Support Allowance

• Income-based Jobseeker’s Allowance

• Guarantee Credit element of State Pension Credit

• Housing Benefit

• Council Tax Reduction/Support – also known by other names (not the 25% single person discount or the Class U exemption)

• Local Housing Allowance

• A combination of Working Tax Credit and at least one of:

– Child Tax Credit

– Disability Element of Working Tax Credit

– Severe Disability Element of Working Tax Credit

Not included: Disability Living Allowance, Invalidity Benefit, Personal Independence Payment Exception

If the donor has been awarded personal injury damages of more than £16,000 which were ignored when they were assessed for one of the above benefits, they won’t qualify for exemption. Supporting evidence for exemption

You need to send copies of letters from a benefit provider showing the donor received at least 1 of the listed benefits at the time you applied to register. Letters must confirm that the benefit was being paid to the donor and include their printed details (title, full name, address and postcode).

Remission based on income

If the donor’s gross annual income is less than £12,000, they may be eligible for a 50% reduction of the fee. Gross annual income is income before tax. It may come from employment, non-means-tested benefits (such as Attendance Allowance, Disability Living Allowance or Personal Independence Payment), pensions, Pensions Savings Credit, interest from savings and investments, or the rent of property.

Supporting evidence for remission

You need to send proof of the donor’s gross annual income. Evidence must relate to the time you sent the application to register. We can’t accept bank statements.

Evidence can be:

Paid employment – A P60 or 3 months’ consecutive wage slips from current employment.

Non-means-tested benefits and pensions – an official letter or notice from the payer.

Interest from capital, stocks, shares or bonds – statements or vouchers showing gross income.

Self-employment – most recent self-assessment tax return and HMRC tax calculation, or audited account certified by a qualified accountant.

If the donor receives no income, they must send a signed statement explaining how they support themselves. If they don’t have mental capacity their attorney or solicitor can supply and sign this statement.

Remission based on Universal Credit

A donor may qualify for remission if they receive Universal Credit.

Supporting evidence of Universal Credit

You need to send copies of letters showing the donor received Universal Credit at the time you applied to register. Letters must confirm that the benefit was being paid to the donor and include their printed details (title, full name, address and postcode)

Hardship

If the donor doesn’t qualify for remission or exemption, but paying fees would cause hardship – for example, paying would mean they couldn’t meet normal living costs – you can apply to have fees waived. To claim write to OPG explaining why payment would cause hardship, enclosing bank statements and other documents showing all savings, income and outgoings.

I have read the exceptions*

I would like the relevant forms to be sent with my documents.Do not apply to me.

CANCELLATION WAIVER Under the Society of Will Writer’s Terms and Conditions, you have a 14-day period in which to cancel your order; Most people want to receive their documentation as soon as possible, if this is your preference then select the option to proceed ASAP, with your confirmation that you wish to proceed straight away and we will produce documents for you. The 14-day period starts from the point you completed a form or gave us relevant information to produce your Will or other documents.*

Proceed ASAPDo not proceed until after 14 daysNeed to discuss options

Saxon Wills & Estate Planning.

www.saxonwills.co.uk enquiry@saxonwills.co.uk

Lasting Power of Attorneys..