Form COP1A
Q1. Annex A: Supporting information for property and financial affairs applications
Guidance: Please refer to COP1A guidance before completing this form. It is important that this annex form is fully completed. If you do not have enough information you should consider asking for an interim order authorising you to obtain information from banks and other financial institutions. Please note: This annex must be submitted with COP1.
Q2. Date received
Q3. Full name of person to whom the application relates (this is the name of the person who lacks, or is alleged to lack, capacity)
Section 1
Q4. Section 1 - Your details (the applicant) and details of any proposed deputies
Section 1
Q5a. (a) Applicant 1
Proposed deputy? Yes No
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Yes; No; Mr.; Mrs.; Miss; Ms.; Other
Section 1
Q5b. (b) Applicant 2
Proposed deputy? Yes No
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Yes; No; Mr.; Mrs.; Miss; Ms.; Other
Section 1
Q6. (c) Proposed deputy
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Mr.; Mrs.; Miss; Ms.; Other
Section 1
Q7. (d) Proposed deputy
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Mr.; Mrs.; Miss; Ms.; Other
Section 1
Q8. 1.2 Sole deputyship Joint deputyship Joint and several deputyship
Options: Sole deputyship; Joint deputyship; Joint and several deputyship
Section 2
Q9. Section 2 - Enduring power of attorney or lasting power of attorney
Section 2
Q10. 2.1 Has the person to whom the application relates granted a power of attorney, enduring power of attorney or lasting power of attorney? Don’t know
Options: Yes; No; Don't know
Section 2
Q11. If Yes, please state which type(s) the date granted and the date registered (if known).
Date made Date registered
Enduring power of attorney
Lasting power of attorney property and financial affairs
Lasting power of attorney health and welfare
Section 2
Q12. 2.2 Please state the name(s) and address(es) of the attorney(s) named in the power of attorney
Attorney 1
Name
Address
Attorney 2
Name
Address
Attorney 3
Name
Address
Section 2
Q13. 2.3 Has the power of attorney been registered? Yes No Don’t know
If Yes, please explain why the appointment of a deputy is sought
If No, please explain why an application to register the power of attorney has not been made
Options: Yes; No; Don't know
Section 3
Q14. Section 3 - Will
Section 3
Q15. 3.1 Has the person to whom the application relates made a will? Yes No Not known
Options: Yes; No; Not known
Section 3
Q16. If Yes, please attach a copy if possible.
Section 3
Q17. 3.2 If you cannot obtain a copy of the will but you know who holds a copy, please give their name and contact details.
Section 3
Q18. 3.3 Do you seek authority to obtain a copy of the will? Yes No
Options: Yes; No
Section 3
Q19. 3.4 If known, please provide the names of the executor(s) of the will
Section 4
Q20. Section 4 - Income and assets
Section 4
Q21. 4.1 What is the national insurance number of the person to whom the application relates?
Section 4
Q22. 4.2 Is the person to whom the application relates entitled to any benefits? Yes No
If Yes, are the benefits received by the person to whom the application relates? Yes No
If No, please give details of who receives the benefits:
Options: Yes; No
Section 4
Q23. 4.3 Please give details below of all income including social security benefits that the person to whom the application relates is entitled.
Income Annual amount Social security benefits Annual amount
Earnings £ State retirement pension £
Occupational pension £ Pension credit £
Other pensions £ Attendance allowance £
Annuities £ Severe disablement allowance £
Other income £ Disability living allowance £
Trust £ Incapacity benefit £
Interest £ Income support £
Investment income £ Council tax benefit £
£ Child benefit £
£ Other benefits £
Total £ Total £
Section 4
Q24. 4.4 Does the person to whom the application relates have any interest in the estate of someone who has died? Yes No
If No, go to Section 4.5
Name of deceased
Name of executor/administrator
Approximate value of interest in estate
Is an order required to allow the proposed deputy to obtain a grant in order to deal with the estate of the deceased? Yes No
Options: Yes; No
Section 4
Q25. Damages and criminal injuries compensation
4.5 Has a claim been made for an award for damages or, for compensation from the Criminal Injuries Compensation Authority or is such a claim likely to be made? Yes No
If No, go to Section 4.8
If Yes, please give details, including the name and address of solicitors involved, the present position regarding the litigation, the likely value of the claim and details of any interim payments that have been, or are going to be, made.
Options: Yes; No
Section 4
Q26. 4.6 If a final award has been made please provide details
Copy of final order enclosed
Section 4
Q27. 4.7 If the award is in excess of £500,000 please annex a brief statement providing the following details:
(1) Any proposed major capital expenditure (e.g. property)
(2) A budget setting out annual income and the projected annual costs of care
(3) Investment proposal in outline if known
Section 4
Q28. 4.8 Does the person to whom the application relates have any money held in bank or building society accounts (or similar)? Yes No
If No, go to Section 4.9
(You must include any money held at the Court Funds Office)
Bank/Building Society Account Type of Names on the account Balance (or similar accounts) Number account
Total
Options: Yes; No
Section 4
Q29. 4.9 Does any other person or organisation (other than those already mentioned) hold money for, or owe money to, the person to whom the application relates? Yes No
If Yes, please give full details including the name and address of those involved the amount held and the reason for holding the money, or the amount owed and reason for loan.
Options: Yes; No
Section 4
Q30. Investments
4.10 Does the person to whom the application relates own any investments such as stocks and shares, unit trusts, bonds etc? Yes No
If Yes, please provide an approximate value of the investments held and the name of the fund manager (if applicable)
Total
Options: Yes; No
Section 4
Q31. Land and property
Section 4
Q32. 4.11 Does the person to whom the application relates own any land or property? Yes No
If Yes, please enter details below If No, go to Section 4.13
Property 1 - address
Market value
Balance of any outstanding mortgage or other legal charge (e.g. equity release)
If the property is not owned solely by the person to whom the application relates please provide the following information:
How is the property held? Joint tenants Tenants in common
Name and address of the co-owner(s):
1 Name Address
2 Name Address
3 Name Address
What is the percentage share to which the person to whom the application relates is entitled?
Options: Joint tenants; Tenants in common
Section 4
Q33. Property 2 - address
Market value
Balance of any outstanding mortgage or other legal charge (e.g. equity release)
If the property is not owned solely by the person to whom the application relates please provide the following information:
How is the property held? Joint tenants Tenants in common
Name and address of the co-owner(s):
1 Name Address
2 Name Address
3 Name Address
What is the percentage share to which the person to whom the application relates is entitled?
Section 4
Q34. If more than 2 properties, please continue on a separate sheet
Section 4
Q35. 4.12 Is authority sought to sell the property (properties)? Yes No
If Yes and there is more than one property, please specify which 1 2 3 property is to be sold
If No, please set out proposals for dealing with the property (properties) below:
Important: If a property is held in joint names, the deputy, when appointed, will not have the legal authority to deal with its sale. This also applies when a property is held as tenants in common and the co-owner is deceased. Please refer to guidance notes for further information.
Options: Yes; No
Section 4
Q36. Personal possessions
Section 4
Q37. 4.13 Please provide details of any possessions with an approximate overall value in excess of £10,000 (e.g. paintings, antiques, collections)
Total value
Section 4
Q38. Business
Section 4
Q39. 4.14 Does the person to whom the application relates own or have any interest in a business? Yes No
If Yes, please provide the following:
a) the name and nature of the business and its legal status, e.g. partnership, sole trader etc.
b) the approximate value of the business
c) the value of the share owned by the person to whom the application relates and their role in the business
d) a draft of any directions or order sought in relation to the business
Options: Yes; No
Section 4
Q40. Expenditure
Section 4
Q41. 4.15 Please provide details of the annual costs of care (maintenance)
Where the person to whom the application relates lives in a nursing/care home, are they liable to contribute towards the cost? Yes No
If Yes, what is the weekly amount?
Options: Yes; No
Section 4
Q42. Debts and money owed
Section 4
Q43. 4.16 Does the person to whom the application relates have any outstanding debts in excess of £1,000? Yes No
If Yes, please give details of any debts of the person to whom the application relates including the name(s) of any creditors and the amount of the debt.
Creditor Amount
Total
Options: Yes; No
Section 5
Q44. Section 5 - Visits
Section 5
Q45. Please provide details of who visits the person to whom the application relates and how often.
Section 6
Q46. Section 6 - Other information
Section 6
Q47. Please provide any background or additional information which you think might be relevant, or of assistance to the court, when making its decision, including consideration of section 4(6) of the Mental Capacity Act 2005.
Section 7
Q48. Section 7 - Statement of truth
Section 7
Q49. (I believe) (The applicant(s) believe(s)) that the facts stated in this annex are true.
Applicant (1) Applicant (2)
Signed Signed
*Applicant(’s litigation friend)(’s solicitor) *Applicant(’s litigation friend)(’s solicitor)
Name Name
Date Date
Name Name
of frm of frm
Position or Position or
offce held offce held
* Please delete the options in brackets that do not apply.
If there are more than 2 applicants, please continue on a separate sheet.
Q1. Annex A: Supporting information for property and financial affairs applications
Guidance: Please refer to COP1A guidance before completing this form. It is important that this annex form is fully completed. If you do not have enough information you should consider asking for an interim order authorising you to obtain information from banks and other financial institutions. Please note: This annex must be submitted with COP1.
Q2. Full name of person to whom the application relates (this is the name of the person who lacks, or is alleged to lack, capacity)
Section 1 - Your details (the applicant) and details of any proposed deputies
Q3a. Section 1 - Your details (the applicant) and details of any proposed deputies
1.1 (a) Applicant 1
Proposed deputy? Yes No
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Yes; No; Mr.; Mrs.; Miss; Ms.; Other
Section 1 - Your details (the applicant) and details of any proposed deputies
Q3b. (b) Applicant 2
Proposed deputy? Yes No
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Yes; No; Mr.; Mrs.; Miss; Ms.; Other
Section 1 - Your details (the applicant) and details of any proposed deputies
Q3c. (c) Proposed deputy
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Mr.; Mrs.; Miss; Ms.; Other
Section 1 - Your details (the applicant) and details of any proposed deputies
Q3d. (d) Proposed deputy
Mr. Mrs. Miss Ms. Other
First name(s)
Last name
Options: Mr.; Mrs.; Miss; Ms.; Other
Section 1 - Your details (the applicant) and details of any proposed deputies
Q4. 1.2 Sole deputyship Joint deputyship Joint and several deputyship
Options: Sole deputyship; Joint deputyship; Joint and several deputyship
Section 2 - Enduring power of attorney or lasting power of attorney
Q5. Section 2 - Enduring power of attorney or lasting power of attorney
Section 2 - Enduring power of attorney or lasting power of attorney
Q6. 2.1 Has the person to whom the application relates granted a power of attorney, enduring power of attorney or lasting power of attorney? Don’t know
Options: Yes; No; Don't know
Section 2 - Enduring power of attorney or lasting power of attorney
Q7. If Yes, please state which type(s) the date granted and the date registered (if known). Date made Date registered
Enduring power of attorney
Lasting power of attorney property and financial affairs
Lasting power of attorney health and welfare
Section 2 - Enduring power of attorney or lasting power of attorney
Q8. 2.2 Please state the name(s) and address(es) of the attorney(s) named in the power of attorney
Attorney 1
Name
Address
Attorney 2
Name
Address
Attorney 3
Name
Address
Section 2 - Enduring power of attorney or lasting power of attorney
Q9. 2.3 Has the power of attorney been registered? Yes No Don’t know
If Yes, please explain why the appointment of a deputy is sought
If No, please explain why an application to register the power of attorney has not been made
Options: Yes; No; Don't know
Section 3 - Will
Q10. Section 3 - Will
Section 3 - Will
Q11. 3.1 Has the person to whom the application relates made a will? Yes No Not known
Options: Yes; No; Not known
Section 3 - Will
Q12. If Yes, please attach a copy if possible.
Section 3 - Will
Q13. 3.2 If you cannot obtain a copy of the will but you know who holds a copy, please give their name and contact details.
Section 3 - Will
Q14. 3.3 Do you seek authority to obtain a copy of the will? Yes No
Options: Yes; No
Section 3 - Will
Q15. 3.4 If known, please provide the names of the executor(s) of the will
Section 4 - Income and assets
Q16. Section 4 - Income and assets
Section 4 - Income and assets
Q17. 4.1 What is the national insurance number of the person to whom the application relates?
Section 4 - Income and assets
Q18. 4.2 Is the person to whom the application relates entitled to any benefits? Yes No
If Yes, are the benefits received by the person to whom the application relates? Yes No
If No, please give details of who receives the benefits:
Options: Yes; No
Section 4 - Income and assets
Q19. 4.3 Please give details below of all income including social security benefits that the person to whom the application relates is entitled.
Income Annual amount Social security benefits Annual amount
Earnings £ State retirement pension £
Occupational pension £ Pension credit £
Other pensions £ Attendance allowance £
Annuities £ Severe disablement allowance £
Other income £ Disability living allowance £
Trust £ Incapacity benefit £
Interest £ Income support £
Investment income £ Council tax benefit £
£ Child benefit £
£ Other benefits £
Total £ Total £
Section 4 - Income and assets
Q20. 4.4 Does the person to whom the application relates have any interest in the estate of someone who has died? Yes No
If No, go to Section 4.5
Name of deceased
Name of executor/administrator
Approximate value of interest in estate
Is an order required to allow the proposed deputy to obtain a grant in order to deal with the estate of the deceased? Yes No
Options: Yes; No
Section 4 - Income and assets
Q21. Damages and criminal injuries compensation
4.5 Has a claim been made for an award for damages or, for compensation from the Criminal Injuries Compensation Authority or is such a claim likely to be made? Yes No
If No, go to Section 4.8
If Yes, please give details, including the name and address of solicitors involved, the present position regarding the litigation, the likely value of the claim and details of any interim payments that have been, or are going to be, made.
Options: Yes; No
Section 4 - Income and assets
Q22. 4.6 If a final award has been made please provide details
Copy of final order enclosed
Section 4 - Income and assets
Q23. 4.7 If the award is in excess of £500,000 please annex a brief statement providing the following details:
(1) Any proposed major capital expenditure (e.g. property)
(2) A budget setting out annual income and the projected annual costs of care
(3) Investment proposal in outline if known
Section 4 - Income and assets
Q24. 4.8 Does the person to whom the application relates have any money held in bank or building society accounts (or similar)? Yes No
If No, go to Section 4.9
(You must include any money held at the Court Funds Office)
Bank/Building Society Account Type of Names on the account Balance
(or similar accounts) Number account
Total
Options: Yes; No
Section 4 - Income and assets
Q25. 4.9 Does any other person or organisation (other than those already mentioned) hold money for, or owe money to, the person to whom the application relates? Yes No
If Yes, please give full details including the name and address of those involved the amount held and the reason for holding the money, or the amount owed and reason for loan.
Options: Yes; No
Section 4 - Income and assets
Q26. Investments
4.10 Does the person to whom the application relates own any investments such as stocks and shares, unit trusts, bonds etc? Yes No
If Yes, please provide an approximate value of the investments held and the name of the fund manager (if applicable)
Total
Options: Yes; No
Section 4 - Income and assets
Q27. Land and property
Section 4 - Income and assets
Q28. 4.11 Does the person to whom the application relates own any land or property? Yes No
If Yes, please enter details below If No, go to Section 4.13
Property 1 - address
Market value
Balance of any outstanding mortgage or other legal charge (e.g. equity release)
If the property is not owned solely by the person to whom the application relates please provide the following information:
How is the property held? Joint tenants Tenants in common
Name and address of the co-owner(s):
1 Name Address
2 Name Address
3 Name Address
What is the percentage share to which the person to whom the application relates is entitled?
Options: Joint tenants; Tenants in common
Section 4 - Income and assets
Q29. Property 2 - address
Market value
Balance of any outstanding mortgage or other legal charge (e.g. equity release)
If the property is not owned solely by the person to whom the application relates please provide the following information:
How is the property held? Joint tenants Tenants in common
Name and address of the co-owner(s):
1 Name Address
2 Name Address
3 Name Address
What is the percentage share to which the person to whom the application relates is entitled?
If more than 2 properties, please continue on a separate sheet
Section 4 - Income and assets
Q30. 4.12 Is authority sought to sell the property (properties)? Yes No
If Yes and there is more than one property, please specify which 1 2 3 property is to be sold
If No, please set out proposals for dealing with the property (properties) below:
Important: If a property is held in joint names, the deputy, when appointed, will not have the legal authority to deal with its sale. This also applies when a property is held as tenants in common and the co-owner is deceased. Please refer to guidance notes for further information.
Options: Yes; No
Section 4 - Income and assets
Q31. Personal possessions
Section 4 - Income and assets
Q32. 4.13 Please provide details of any possessions with an approximate overall value in excess of £10,000 (e.g. paintings, antiques, collections)
Total value
Section 4 - Income and assets
Q33. Business
Section 4 - Income and assets
Q34. 4.14 Does the person to whom the application relates own or have any interest in a business? Yes No
If Yes, please provide the following:
a) the name and nature of the business and its legal status, e.g. partnership, sole trader etc.
b) the approximate value of the business
c) the value of the share owned by the person to whom the application relates and their role in the business
d) a draft of any directions or order sought in relation to the business
Options: Yes; No
Section 4 - Income and assets
Q35. Expenditure
Section 4 - Income and assets
Q36. 4.15 Please provide details of the annual costs of care (maintenance)
Where the person to whom the application relates lives in a nursing/care home, are they liable to contribute towards the cost? Yes No
If Yes, what is the weekly amount?
Options: Yes; No
Section 4 - Income and assets
Q37. Debts and money owed
Section 4 - Income and assets
Q38. 4.16 Does the person to whom the application relates have any outstanding debts in excess of £1,000? Yes No
If Yes, please give details of any debts of the person to whom the application relates including the name(s) of any creditors and the amount of the debt.
Creditor Amount
Total
Options: Yes; No
Section 5 - Visits
Q39. Section 5 - Visits
Section 5 - Visits
Q40. Please provide details of who visits the person to whom the application relates and how often.
Section 6 - Other information
Q41. Section 6 - Other information
Section 6 - Other information
Q42. Please provide any background or additional information which you think might be relevant, or of assistance to the court, when making its decision, including consideration of section 4(6) of the Mental Capacity Act 2005.
Section 7 - Statement of truth
Q43. Section 7 - Statement of truth
Section 7 - Statement of truth
Q44. (I believe) (The applicant(s) believe(s)) that the facts stated in this annex are true.
Applicant (1) Applicant (2)
Signed Signed
*Applicant(’s litigation friend)(’s solicitor) *Applicant(’s litigation friend)(’s solicitor)
Name Name
Date Date
Name Name
of frm of frm
Position or Position or
offce held offce held
* Please delete the options in brackets that do not apply.
If there are more than 2 applicants, please continue on a separate sheet.