Lasting Powers of Attorney Instruction Form
Date: ______Asst. Name:______
Is this a: Property & Financial Affairs LPA: Health & Welfare LPA: For both LPA’s:
Client’s name and Contact Details
Client A / Client BTitle: Mr, Mrs…
Full name:
Other/maiden name
Date of Birth:
Address:
Postcode:
Phone number:
Confirm the client possesses mental capacity:
FOR PROPERTY & FINANCIAL AFFAIRS LPA ONLY: Specific options as to when the LPA can be used. The two options are: - on registration or only on loss of mental capacity. NB. The OPG warns that limiting to incapacity can restrict its usefulness.
On Loss of Mental Capacity: (Not Recommended) / YES: / NO:Who will act as Attorneys?
1st Attorney: / Client A / Client BTitle Mr, Mrs…
Full name:
Date of birth:
Relationship to donor:
Occupation:
Address:
Phone number:
2nd Attorney: / Client A / Client B
Title Mr, Mrs…
Full name:
Date of birth:
Relationship to donor:
Occupation:
Address:
Phone number:
3rd Attorney: / Client A / Client B
Title Mr, Mrs…
Full name:
Date of birth:
Relationship to donor:
Occupation:
Address:
Phone number:
4th Attorney: / Client A / Client B
Title Mr, Mrs…
Full name:
Date of birth:
Relationship to donor:
Occupation:
Address:
Phone number:
How are the Attorneys to act? Tick one of the following:
Client A / Client BJointly: (Not Recommended)
(Jointly means all Attorneys have to agree to all decisions)
Jointly & severally:
(This means all Attorneys can act independently of each other)
Jointly for some decisions and jointly and severally for other decisions:
(Attorneys have to act jointly only on some specific matters)
Where jointly for some decisions and jointly and severally for other decisions – GUIDANCE: only use this category if absolutely essential
Client A / Client BJointly on which matters:
Jointly& severally on all other matters? Tick Yes
Replacement Attorneys
Client A / Client B1st replacement
Title (Mr, Mrs…)
Full name:
Address:
Date of birth:
Relationship to donor:
Occupation:
Phone number:
Client A / Client B
2nd replacement
Title (Mr, Mrs…)
Full name:
Address:
Date of birth:
Relationship to donor:
Occupation:
Phone number:
How are the replacement Attorneys to act?
Client A / Client BJointly: (Not Recommended)
(Jointly means all Attorneys have to agree to all decisions)
Jointly & severally:
(This means all Attorneys can act independently of each other)
Jointly for some decisions and jointly and severally for other decisions:
(Attorneys have to act jointly only on some specific matters)
When are the replacement Attorneys to act?
Client A / Client BWhen any attorney cannot act
When all attorneys cannot act
PREFERENCES & INSTRUCTIONS
This section may place any restrictions or conditions on their Attorneys abilities: which their Attorneys are legally obliged to follow (you must ensure that these are clear, unambiguous and workable) (Not Recommended:
Optional Instructions (only if applicable) please tick if requiredMy attorney(s) may transfer my investments into a discretionary management scheme, or if I already had investments in a discretionary management scheme before I lost capacity to make financial decisions, I want the scheme to continue. I understand in both cases that managers of the scheme will make investment decisions and my investments will be held in their names or the names of their nominees.
I wish to use the following wording from my Discretionary Fund manager:-
If a Property & Financial Affairs LPA – / Client A / Client B
Can Attorneys view contents of will?:YES/NO
OPTIONAL - Notifying others when application is made to register the Lasting Power of Attorney by client(s) or their Attorneys.
Client A / Client BTitle (Mr, Mrs.)
Full name:
Address:
Postcode:
Phone number:
Title (Mr, Mrs.)
Full name:
Address:
Postcode:
Phone Number:
FOR HEALTH & WELFARE LPAs ONLY
This section should only be completed if the client(s) has requested the Lasting Power of Attorney relating to health and welfare matters, and must be completed by the client(s).
Life Sustaining Treatment
Where the client(s) authorise their Attorneys to make decisions on life sustaining treatment:
Client A / Client BI grant my Attorneys authority to give or refuse consent to life sustaining treatment on my behalf? / I grant my Attorneys authority to give or refuse consent to life sustaining treatment on my behalf?
Signature: / Signature:
Print name: / Print name:
OR
Where the client(s) DO NOT AUTHORISE their Attorneys to make decisions on life sustaining treatment:
Client A / Client BI DO NOT grant my Attorneys authority to give or refuse consent to life sustaining treatment on their behalf? / I DO NOT grant my Attorneys authority to give or refuse consent to life sustaining treatment on their behalf?
Signature: / Signature:
Print name: / Print name:
Does the client have an existing living will or advance decision?
If so, is this LPA compatible with the pre-existing above document or are there any conflicts of directions or differences?
The Certificate Provider – Only ONE Required
The client has requested the APS Legal Associate to act as their certificate provider (confirm YES):
OR:
Client has known this person personally for at least two years, and this is more than a passing acquaintance.
Title (Mr, Mrs…)Full name:
Address:
Phone number:
Email:
The following cannot act as a certificate provider to the client:
Members of the family / Attorney of client through another E/LPABusiness partner or employee / Owner, director, manager or employee of client’s care home
REGISTERING A LASTING POWER OF ATTORNEY – ADVICE FOR THE CLIENT
There are risks in NOT registering a Lasting Power of Attorney immediately:
- whilst the LPA being drafted will meet our existing awareness of Office of the Public Guardian (OPG) requirements, OPG policy may change in the future, rendering the drafted LPA at risk of failing the registration process.
- If a new Lasting Power is required due to failure of this Power when later submitted for registration, and you have lost mental capacity it will not be possible for you to effect a new Power. Your “attorneys” will instead need to apply for deputyship.
- Registration costs may increase and the process may change.
- Should registration be deferred until it is needed, there will be a significant delay in your Attorneys being able to legally control your assets or be legally authorised to make decisions on your health and welfare, as they will need to register this Lasting Power on your behalf.
It is for these reasons that APS recommend this Lasting Power is registered immediately once signed by all parties. You must be aware, however, that once registered, you will not be able to make changes to this Power – in order to effect changes you will need to revoke this Power, write a new Power and register that new Power.
I understand that my Lasting Power of Attorney has to be registered with the Office of the Public Guardian (OPG) before my Attorneys can use it. The charge the OPG levy for this is £82 unless fee exemptions or remissions apply. APS will charge a further fee for registering this Lasting Power (see separate fees list).
OPG Registration Fees Exemptions and Remissions
The Office of the Public Guardian charges a £82 Lasting Power of Attorney registration fee. This fee applies to all registrations and is applied to EACH Lasting Power of Attorney submitted. However, certain exemptions and remissions to this fee apply.
WHEN ARE OPG FEES FULLY EXEMPT?
If the client is in receipt of any the following benefits they are 100% exempt from paying the OPG fee:
Income Support; Income-based Job-Seeker’s Allowance; Income-based Employment and Support Allowance; State Pension Guarantee Credit element of pension credit; A combination of Working Tax Credit and either Child Tax Credit, Disability Element or Severe Disability Element or Housing/Council Tax benefit (but not the 25% single occupancy reduction)
IF AN EXEMPTION APPLIES, WHAT INFORMATION IS NEEDED?
Up to date documentary evidence of the above benefit as appropriate.
WHO QUALIFIES FOR 50% REMISSION OF FEES?
If the client is not in receipt of any of those benefits above but has an annual income of less than £12,000 they may be eligible for a 50% remission and so only need to pay £41.
IF A REMISSION APPLIES, WHAT INFORMATION IS NEEDED?
The OPG request 3 month’s most recent bank statements (must show client’s name and address) plus a recent letter or statement confirming their gross income, i.e. for pensions, benefits etc. Please note that online bank statements or bills aren’t accepted.
ASSOCIATE - IF IN ANY DOUBT ABOUT WHAT YOU NEED TO SEND PLEASE CONTACT THE HELPLINE
CONFIRMATION OF INSTRUCTIONS
- I/we confirm that I/we am/are over the age of eighteen and am/are of sound mind. The information provided is complete and correct and is to be used to prepare my/ our Lasting Power of Attorney document(s).
- I/we hereby agree we will not hold APS Legal & Associates responsible or liable in any way for events arising from my/our decision not to pursue any advice provided to me/us.
- I/we understand that APS Legal & Associates has explained to me/us the relevance of the options regarding Lasting Powers of Attorney documents and how they apply to my/our personal circumstances.
The LPA Document(s)
Lasting Power of Attorney / Property & Financial Affairs / Single / YES/ NOProperty & Financial Affairs / Couple / YES/ NO
Lasting Power of Attorney / Health & Welfare / Single / YES/ NO
Health & Welfare / Couple / YES/ NO
The Registration
1st Client / 2nd ClientAre APS to register LPA immediately? Yes or No
If YES…
Is exemption available?
If YES – no registration fee applies
Is remission available?
If YES – registration fee is £41 per LPA
Where no remission available: £82 per LPA
IF REGISTRATION REQUIRED – ensure the client is aware that when the LPA and registrations are completed and ready for submission up to date documentary evidence of income will be required and a cheque payable to the Office of the Public Guardian for OPG registration fees WHEN LPA and registration forms have been fully completed.
CONFIRMATION:
Signature of Client A:______Date:______
Name:______
Signature of Client B:______Date:______
Name:______
ASSOCIATE – PLEASE ENSURE ALL FIELDS ON THIS FORM ARE COMPLETED BEFORE CONFIRMING INSTRUCTIONS
Confirmation of Associate:
Signature of Associate:______Date:______
Name:______
FOR APS LEGAL & ASSOCIATES USE ONLY
Certification.
Please minute the responses by the client(s) to the following questions. The purpose of this is to confirm capacity and that no undue influence was brought to bear on the clients.
Question / Client A Response / Client B ResponseWhat is your understanding of an LPA?
Who suggested you made an LPA?
Why do you want to make an LPA?
Who are you appointing as your Attorneys (names only)?
Why have you chosen these Attorneys in particular?
What powers have you given your Attorneys?
Has anyone pressurised you to make this LPA?
Also present at the meeting:
Tick to confirm your belief of no undue influence or pressure from other attendees:
Please list here any comments or special instructions relating to the case (for the benefit of APS Legal & Associates):LPA Instruction form V8 – Apl 17 Page 3 of 9