LPA Online Questionnaire, Ready to Proceed? Complete in Minutes!

Before completing the online questionnaire, you will need to have the following information prepared:

Details of the 'donor'

This is the person, probably elderly or disabled, who wishes to appoint one or more people to manage his or her affairs.

If he or she has already lost mental capacity and is unable to make decisions, you cannot proceed.

If the donor is still able to make decisions, you may complete this questionnaire on the donor’s behalf. You must provide the donor’s FULL NAME (including any middle names), address and date of birth.

Details of the 'attorney(s)'

The donor may appoint a minimum of ONE and a maximum of FOUR ‘attorneys’.

These are the people who will be able to manage the donor’s affairs if he or she is unable to do so for himself or herself.

Anyone over 18 can act as an attorney, except a declared bankrupt.

You must provide the FULL NAME (including any middle names), address and date of birth of each attorney.

Details of the 'certificate provider'

This is a person who certifies that the donor is capable of understanding the implications of making Lasting Power of Attorney and is appointing the Attorney(s) of his or her own free will and is not being unduly influenced or pressured.

Your Dedicated Account Manager will call you to explain this role further and collect the required information within 3 working days of receiving your application. We may contact the chosen Certificate Provider to confirm the validity of the application.

Payment Details

At Step 10 you will be prompted to enter your debit or credit card details. We accept Visa, Maestro or Mastercard. Please note that we do not store any card details.

It will take approximately 15 minutes to complete this questionnaire.
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TERMS & CONDITIONS
Accept*
- I have prepared all the above information, read and understood the terms and conditions and am ready to proceed

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DONOR
Donor

This is the person, probably elderly or disabled, who wishes to appoint one or more people to manage his or her affairs.

If he or she has already lost mental capacity and is unable to make decisions, you cannot proceed.

If the donor is still able to make decisions, you may complete this questionnaire on the donor’s behalf. You must provide the donor’s FULL NAME (including any middle names), address and date of birth.
Title*
Full Name (including middle names)*
Date of Birth*
Address*
Postcode*
Phone Number*

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ATTORNEY
Attorney(s)

The donor may appoint a minimum of ONE and a maximum of FOUR ‘attorneys’. These are the people who will be able to manage the donor’s affairs if he or she is unable to do so for himself or herself.

Anyone over 18 can act as an attorney, except a declared bankrupt.

You must provide the FULL NAME (including any middle names), address and date of birth of each attorney.
Number of Attorneys*
➊ First Attorney
Title*
Full Name (including middle names)*
Date of Birth*
Address*
Postcode*
Phone Number*
➋ Second Attorney
Title*
Full Name (including middle names)*
Date of Birth*
Address*
Postcode*
Phone Number*
➌ Third Attorney
Title*
Full Name (including middle names)*
Date of Birth*
Address*
Postcode*
Phone Number*
➍ Fourth Attorney
Title*
Full Name (including middle names)*
Date of Birth*
Address*
Postcode*
Phone Number*
HOW ARE THE ATTORNEYS TO ACT?
How Are The Attorneys to Act?

If more than one Attorney is appointed, they will either act JOINTLY (in which case, they must always be together when required to act, for example, in visiting the bank) or JOINTLY AND SEVERALLY (in which case they may act jointly, but they can also act independently).

JOINTLY AND SEVERALLY is generally considered to be the best choice.
Working Relationship*

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REPLACEMENT ATTORNEY
Replacement Attorney(s)

The donor may appoint ‘replacement attorneys’, who would be able to stand in for an attorney who became unable to act. This is usually only necessary if a single attorney has been appointed. Again, full name, address and date of birth are required.
Do you wish to appoint replacement attorneys?*
➊ First Replacement Attorney
Title*
Full Name (including middle names)*
Date of Birth*
Address*
Postcode*
➋ Second Replacement Attorney
Title*
Full Name (including middle names)*
Date of Birth*
Address*
Postcode*

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APPLICANT
Applicant

Who is the ‘applicant’? When the completed forms have been sent to the Office of the Public Guardian to be registered, they will contact the ‘applicant’ in order to collect the registration fee (if applicable). Will the applicant be the donor or an attorney?
Who is the Applicant?*
Which attorney?*
Which attorney?*
Which attorney?*
Which attorney?*

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CORRESPONDENCE
Correspondence

Who will receive correspondence? Does the donor wish to receive correspondence relating to the Lasting Power of Attorney, or should this be sent to an attorney?
Who will receive correspondence?*
Which attorney?*
Which attorney?*
Which attorney?*
Which attorney?*

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INCOME & BENEFITS
Income & Benefits

If the donor’s annual income is more than £12,000 gross, he or she will pay a registration fee of £82 for each individual application.

If his or her total income is less than £12,000 the registration fee is reduced to £41 for each Lasting Power of Attorney.

If the donor is in receipt of certain means-tested state benefits, he or she will be exempt from the registration fee.
Is the Donors gross annual income less than £12,000?*
Is the donor in receipt of any of the following means tested benefits?
- Income Support
- Income-based Employer and Support Allowance
- Income-base jobseekers Allowance
- Guaranteed Credit element of State Pension Credit
- Housing Benefit
- Council Tax Reduction or Support (Not the 25% Single Person Discount, known as 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

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COVERAGE
Coverage*
Please select the option(s) you would like this document to cover.
- I want LPA for Financial & Property matters - £100.00
- I want LPA for Health & Welfare matters - £100.00
- I want LPA for Both Financial & Property and Health & Welfare - £200.00
How should attorney's act?*
If the donor requires LPA for Property & Financial Affairs, does he or she want this to take effect immediately after registration, or only if and when he or she loses mental capacity? (PLEASE NOTE: In the case of Health & Welfare, this can only take effect if the donor loses mental capacity).

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ATTENTION! Please check ALL information that you are about to submit (Full names, Dates of birth, Addresses) as any charges we incur due to incorrect information supplied to us, these charges shall be payable by you.

If you need to correct anything, please use the back arrow at the bottom to go back and make the relevant changes.

Remember, your Dedicated Account Manager will contact you to explain and collect the information of the Certificate Provider. We may contact the chosen Certificate Provider to confirm the validity of the application.
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PAYMENT
Total To Be Charged
£ 0.00
Credit Card*
Please enter your credit/debit card details below. We accept MasterCard, Visa and Maestro.
Card Details
Cardholder Name
Billing Address*
Please enter the billing address associated with the card you are paying with.

Street Address Address Line 2 City County Postcode
Email*

We'll use this email address to send you confirmation of your order.
Telephone*
We'll only use this to contact you should there be a problem with your order.

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LPA Questionnaire

Step 1 of 10 - Gather Information

Details of the 'donor'

Details of the 'attorney(s)'

Details of the 'certificate provider'

Payment Details

TERMS & CONDITIONS

DONOR

ATTORNEY

➊ First Attorney

➋ Second Attorney

➌ Third Attorney

➍ Fourth Attorney

HOW ARE THE ATTORNEYS TO ACT?

REPLACEMENT ATTORNEY

➊ First Replacement Attorney

➋ Second Replacement Attorney

APPLICANT

CORRESPONDENCE

INCOME & BENEFITS

COVERAGE

PAYMENT