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Power of Attorney

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If this power of attorney will be used to grant the person(s) who shall become the attorney(s) with powers over decisions which relate to the Granter's welfare, e.g. medical treatment, social care etc, please select "Welfare". If this power of attorney will be used to grant the person(s) who shall become the attorney(s) with powers over decisions which relate to the Granter's property and finances e.g. controlling the Granter's money, maintaining their house and bank accounts, please select "Property and finances". If this power of attorney will be used to grant the person(s) who shall become the attorney(s) with powers over decisions which relate to the Granter's welfare and their property and finances, e.g. what medical treatment is appropriate and control over the Granter's bank accounts, please select "Both".

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Power of Attorney for Welfare

for use in Scotland

I, ________, residing at:

________

hereby appoint ________ of:

________

(hereafter my "Attorney")

to be my welfare Attorney and them alone and the survivor of them under the terms of section 15 of the Adults with Incapacity (Scotland) Act 2000 ("the Act").

I declare and confirm the following:

I. that this power of attorney is intended to be a welfare power of attorney that shall take effect when I have lost capacity in relation to the matters herein contained;

II. I have considered how my incapacity will be determined;

III. upon the registration of this power of attorney with the Public Guardian, as required under the Act, my Attorney shall be permitted and entitled to exercise the powers specified in this power of attorney in relation to my welfare;

IV. my Attorney shall only be permitted to exercise use of the powers conferred upon them in this power of attorney until such time as they receive written notice that their appointment has been revoked or upon the occurrence of my death;

V. at all times my Attorney shall be subject to the requirements of the Act;

VI. upon the occurrence of me being incapable under the terms of the Act to make decisions regarding my personal welfare, or where my Attorney reasonably believes that to be the case, my Attorney may make decisions on my behalf in relation to my personal welfare;

VII. my Attorney shall receive a copy of this document upon its registration with the Public Guardian;

VIII. any and all decisions that may be made and all documents which may be granted by my Attorney to whatever person or persons shall be equally valid and binding as if such decision or documents were made or granted by me.

My Attorney shall have the following powers regarding decisions which relate to my welfare:

I. where I should be habitually resident;

II. have access to any and all of my personal information held by any organisation;

III. to consent or to reasonably withhold consent to any medical treatment which may be administered in accordance with what is legally permitted under the terms of the Act;

IV. to consult with any relevant and necessary medical professional on my behalf;

V. provide consent for my participation in medical research where in accordance with all relevant safeguards as set out in Part 5 of the Act;

VI. to arrange medical, dentistry or any other necessary treatments to the benefit of my health;

VII. to pursue, defend, compromise or settle any relevant legal actions or proceedings on my behalf which relate to my personal welfare;

VIII. have full access to all and any confidential materials, documents or information concerning me where I would have access to such confidential materials, documents or information on a personal basis;

IX. to make decisions regarding my dress and personal appearance;

X. to make decisions regarding my diet;

XI. to make decisions regarding with whom I should be able to regularly associate and consort with;

XII. to arrange and organise any work, education or training for me to partake in;

XIII. to make decisions regarding any social or cultural events and activities that I should be able to partake in; and

XIV. to take me on holiday or to authorise someone else to take me on holiday.

This power of attorney for welfare is being made by me on ________ at ________ and shall remain in force until such time that it is recalled by me in writing or upon the occurrence of my death.

IN WITNESS WHEREOF by signing this document I consent to registration hereof for preservation and execution:

Signature of ________: ______________________________

Date of signing: ________

Place of signing: ________




Signature of Witness: ______________________________

Print name of Witness (BLOCK CAPITALS): ______________________________

Address of Witness: _____________________________

______________________________________________

______________________________________________

______________________________________________

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Power of Attorney for Welfare

for use in Scotland

I, ________, residing at:

________

hereby appoint ________ of:

________

(hereafter my "Attorney")

to be my welfare Attorney and them alone and the survivor of them under the terms of section 15 of the Adults with Incapacity (Scotland) Act 2000 ("the Act").

I declare and confirm the following:

I. that this power of attorney is intended to be a welfare power of attorney that shall take effect when I have lost capacity in relation to the matters herein contained;

II. I have considered how my incapacity will be determined;

III. upon the registration of this power of attorney with the Public Guardian, as required under the Act, my Attorney shall be permitted and entitled to exercise the powers specified in this power of attorney in relation to my welfare;

IV. my Attorney shall only be permitted to exercise use of the powers conferred upon them in this power of attorney until such time as they receive written notice that their appointment has been revoked or upon the occurrence of my death;

V. at all times my Attorney shall be subject to the requirements of the Act;

VI. upon the occurrence of me being incapable under the terms of the Act to make decisions regarding my personal welfare, or where my Attorney reasonably believes that to be the case, my Attorney may make decisions on my behalf in relation to my personal welfare;

VII. my Attorney shall receive a copy of this document upon its registration with the Public Guardian;

VIII. any and all decisions that may be made and all documents which may be granted by my Attorney to whatever person or persons shall be equally valid and binding as if such decision or documents were made or granted by me.

My Attorney shall have the following powers regarding decisions which relate to my welfare:

I. where I should be habitually resident;

II. have access to any and all of my personal information held by any organisation;

III. to consent or to reasonably withhold consent to any medical treatment which may be administered in accordance with what is legally permitted under the terms of the Act;

IV. to consult with any relevant and necessary medical professional on my behalf;

V. provide consent for my participation in medical research where in accordance with all relevant safeguards as set out in Part 5 of the Act;

VI. to arrange medical, dentistry or any other necessary treatments to the benefit of my health;

VII. to pursue, defend, compromise or settle any relevant legal actions or proceedings on my behalf which relate to my personal welfare;

VIII. have full access to all and any confidential materials, documents or information concerning me where I would have access to such confidential materials, documents or information on a personal basis;

IX. to make decisions regarding my dress and personal appearance;

X. to make decisions regarding my diet;

XI. to make decisions regarding with whom I should be able to regularly associate and consort with;

XII. to arrange and organise any work, education or training for me to partake in;

XIII. to make decisions regarding any social or cultural events and activities that I should be able to partake in; and

XIV. to take me on holiday or to authorise someone else to take me on holiday.

This power of attorney for welfare is being made by me on ________ at ________ and shall remain in force until such time that it is recalled by me in writing or upon the occurrence of my death.

IN WITNESS WHEREOF by signing this document I consent to registration hereof for preservation and execution:

Signature of ________: ______________________________

Date of signing: ________

Place of signing: ________




Signature of Witness: ______________________________

Print name of Witness (BLOCK CAPITALS): ______________________________

Address of Witness: _____________________________

______________________________________________

______________________________________________

______________________________________________