Form LP1F
Section 1
Q1. Title First names Last name
Section 1
Q2. Any other names you’re known by (optional – eg your married name)
Section 1
Q3. Date of birth
Section 1
Q4. Address
Section 1
Q5. Postcode
Section 1
Q6. Email address (optional)
Section 1
Q7. LPA registration date
Section 1
Q8. OPG reference number
Section 2
Q9. Title First names Last name
Section 2
Q10. Date of birth
Section 2
Q11. Address
Section 2
Q12. Postcode
Section 2
Q13. Email address (optional)
Section 2
Q14. This attorney is a trust corporation.
Options: This attorney is a trust corporation.
Section 2 – continued
Q15. Title First names Last name
Section 2 – continued
Q16. Date of birth
Section 2 – continued
Q17. Address
Section 2 – continued
Q18. Postcode
Section 2 – continued
Q19. Email address (optional)
Section 2 – continued
Q20. More attorneys – I want to appoint more than 4 attorneys. Use Continuation sheet 1.
Section 3
Q21. How do you want your attorneys to work together? (tick one only)
Options: Jointly and severally; Jointly; Jointly for some decisions, jointly and severally for other decisions
Section 3
Q22. 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.
Section 3
Q23. 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 (in section 4).
Section 3
Q24. 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 ‘jointly decisions’ your attorneys should make jointly and agree unanimously on Continuation sheet 2. The wording you use is important. There are examples in the Guide, part A3. 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 (in section 4). Your original attorneys will still be able to make any of the other decisions alongside your replacement attorneys.
Section 4
Q25. Title First names Last name
Section 4
Q26. Date of birth
Section 4
Q27. Address
Section 4
Q28. Postcode
Section 4
Q29. This attorney is a trust corporation.
Options: This attorney is a trust corporation.
Section 4
Q30. More replacements – I want to appoint more than two replacements. Use Continuation sheet 1.
Section 4
Q31. When and how your replacement attorneys can act
Section 4
Q32. I want to change when or how my attorneys can act (optional). Use Continuation sheet 2.
Section 5
Q33. When do you want your attorneys to be able to make decisions?
Options: As soon as my LPA has been registered (and also when I don’t have mental capacity); Only when I don’t have mental capacity
Section 5
Q34. 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.
Section 5
Q35. 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.
Section 6
Q36. Title First names Last name
Section 6
Q37. Address
Section 6
Q38. Postcode
Section 6
Q39. Title First names Last name
Section 6
Q40. Address
Section 6
Q41. Postcode
Section 6
Q42. I want to appoint another person to notify (maximum is 5) – use Continuation sheet 1.
Section 7
Q43. Preferences – use words like ‘prefer’ and ‘would like’
Section 7
Q44. Instructions – use words like ‘must’ and ‘have to’
Section 7
Q45. I need more space – use Continuation sheet 2.
Section 9
Q46. Signature or mark
Section 9
Q47. Date signed or marked
Section 9
Q48. Full name of witness
Section 9
Q49. Address
Section 9
Q50. Postcode
Section 10
Q51. Signature or mark
Section 10
Q52. Date signed or marked
Section 10
Q53. Title First names Last name
Section 10
Q54. Address
Section 10
Q55. Postcode
Section 11
Q56. Signature or mark
Section 11
Q57. Date signed or marked
Section 11
Q58. Title First names Last name
Section 11
Q59. Address
Section 11
Q60. Postcode
Section 11
Q61. Signature or mark
Section 11
Q62. Date signed or marked
Section 11
Q63. Full names of witness
Section 11
Q64. Day Month Year
Section 11
Q65. Address
Section 11
Q66. Title First names Last name
Section 11
Q67. Postcode
Section 12
Q68. Who is applying to register the LPA? (tick one only)
Options: Donor – the donor needs to sign section 15; Attorney(s) – If the attorneys were appointed jointly (in section 3) then they all need to sign section 15. Otherwise, only one of the attorneys needs to sign
Section 12
Q69. Title First names Last name
Section 12
Q70. Date of birth
Section 12
Q71. Title First names Last name
Section 12
Q72. Date of birth
Section 13
Q73. Title First names Last name
Section 13
Q74. Last name
Section 13
Q75. Company (optional)
Section 13
Q76. Address
Section 13
Q77. Postcode
Section 13
Q78. How would the person above prefer to be contacted?
Options: Post; Phone; Email; Welsh (we will write to the person in Welsh)
Section 14
Q79. How would you like to pay?
Options: Card; Cheque
Section 14
Q80. Your phone number
Section 14
Q81. I want to apply to pay a reduced fee
Options: I want to apply to pay a reduced fee
Section 14
Q82. I’m making a repeat application
Options: I’m making a repeat application
Section 14
Q83. Case number
Section 14
Q84. Payment reference
Section 14
Q85. Payment date
Section 14
Q86. Amount
Section 15
Q87. Signature or mark
Section 15
Q88. Date signed
Section 15
Q89. Signature or mark
Section 15
Q90. Date signed
Section 15
Q91. Signature or mark
Section 15
Q92. Date signed
Section 15
Q93. Signature or mark
Section 15
Q94. Date signed