First Chapter LPA Questionnaire Couples

  • Your Estate Maintenance Focus™

  • Section 1

    Personal Details - Donor 1
  • Todays Date (Not visible)
     - -

  • Please review the Guidance notes before completing the questionnaire.

     

    We have pre-filled this form for you with everything we have on record about you, your partner and your children (if applicable). Please read these pre-filled fields carefully and correct or amend anything that is inaccurate or has changed since we last recorded your answers. These will automatically update our records once submitted and verified, and will be used in future correspondence with you. Thank you.

     

    You may save your progress at any time by clicking 'Save' - a link will be sent to your (Donor 1) email address to pick up where you left off.

     

  • Client Date of Birth*
     / /
  • Current Marital/Living Status*
  • Do you intend to get married in the near future?
  • Married to Applicant 2?*
  • Date of Marriage*
     - -
  • In the last 7 years have you been;
  • Date of death of spouse
     - -
  • Date of divorce/decree absolute
     - -

  • Section 1.1

    Spouse/Partner Personal Details - Donor 2
  • Address the same as Applicant 1?*
  • Spouse / Partner Date of Birth *
     / /
  • Spouse / Partner Current Marital/Living Status*
  • In the last 7 years have you been;
  • Married to Applicant 1?*
  • Date of Marriage
     - -
  • In the last 7 years, have you been;
  • Date of death of spouse
     - -
  • Date of divorce/decree absolute
     - -

  • Section 1.2

    Your Children/Dependents

  • Eldest child's Full Name

  • Eldest Child Date of Birth *
     / /

  • Second Eldest Child's Full Name

  • 2nd Eldest Child Date of Birth *
     / /

  • Third Eldest Child's Full Name

  • 3rd Eldest Child Date of Birth *
     / /

  • Fourth Eldest Child's Full Name

  • 4th Eldest Child Date of Birth *
     / /

  • Fifth Eldest Child's Full Name

  • 5th Eldest Child Date of Birth *
     / /

  • Sixth Eldest Child's Full Name

  • 6th Eldest Child Date of Birth *
     / /

  • Section 2

    Lasting Power Of Attorney Applicant 1

  • With regards to the interests of {clientName} (Donor 1).

  • Do you have an existing Lasting Power of Attorney (LPA) or Enduring Power of Attorney (EPA), sometimes known as a 'living will'? See (Guide to LPA's)*
  • Has your LPA/EPA been registered with the Office of the Public Guardian? (OPG)*
  • Do you wish to create a new application for Lasting Power of Attorney (LPA?*
  • Please tick which types of LPA you require (please tick one or both)*
  • Do you wish for this application to replace your current LPA/EPA?*

  • Lasting Power of Attorney

    Applicant 2

  • With regards to the interests of {firstName372} (Donor 2).

  • Do you have an existing Lasting Power of Attorney (LPA) or Enduring Power of Attorney (EPA), sometimes known as a 'living will'? See (Guide to LPA's)*
  • Has your LPA/EPA been registered with the Office of the Public Guardian? (OPG)*
  • Do you wish to create a new application for Lasting Power of Attorney (LPA)?*
  • Please tick which types of LPA you require (please tick one or both)*
  • Do you wish for this application to replace your current LPA/EPA?*

  • Please note that whilst an LPA can be established without being registered, it can only be used once it has been registered with the Office of the Public Guardian. Registration can generally take between 8 and 10 weeks to complete in most circumstances, subject to there being no mistakes on the application. Our Legal Partner strongly advises immediate registration on each and every occasion. To this effect, we will prepare for immediate registration in respect of your chosen LPA's unless stated otherwise.

  • Please indicate your response below*

  • Section 3

    Life Sustaining Medical Treatment

  • You must choose in the Health & Welfare LPA whether you wish your Attorney(s) to be able to give or refuse life-sustaining medical treatment, which is based on the circumstances at the time and not the treatment. It does not authorise assisted suicide.

  • With regards to life sustaining medial treatment for {clientName}.

  • Please select;*

  • With regards to life sustaining medial treatment for {firstName372}.

  • Please select;*

  • Section 4

    Attorney Details - Please Select Who You Wish to be Your Attorneys
  • Do you wish to appoint this (Eldest) Child as Attorney?*
  • Do you wish to appoint this (Eldest) Child as a REPLACEMENT Attorney? (Optional)
  • Do you wish to appoint this (2nd Eldest) Child as Attorney?*
  • Do you wish to appoint this (2nd Eldest) Child as a REPLACEMENT Attorney? (Optional)
  • Do you wish to appoint this (3rd Eldest) Child as Attorney?*
  • Do you wish to appoint this (3rd Eldest) Child as a REPLACEMENT Attorney? (Optional)
  • Do you wish to appoint this (4th Eldest) Child as Attorney?*
  • Do you wish to appoint this (4th Eldest) Child as a REPLACEMENT Attorney? (Optional)
  • Do you wish to appoint this (5th Eldest) Child as Attorney?*
  • Do you wish to appoint this (5th Eldest) Child as a REPLACEMENT Attorney? (Optional)
  • Do you wish to appoint this (6th Eldest) Child as Attorney?*
  • Do you wish to appoint this (6th Eldest) Child as a REPLACEMENT Attorney? (Optional)

  • Please add any other nominated Attorney/s here with regards to {clientName}.

  • Please add any other nominated Attorney/s here with regards to {firstName372}.

  • Section 5

    How to Act

  • {clientName} how do you want your Attorney(s) to act

  • Please review the guidance notes, then select one of the following;*

  • {firstName372} how do you want your Attorney(s) to act

  • Please review the guidance notes, then select one of the following;*

  • Section 6

    Restrictions - Restricting how your attorneys act

  • RESTRICTIONS AND GUIDANCE

     

    Without any restrictions your Attorney(s) will be able to make decisions that you are able to make over your property and finances (if you are making a Property & Financial Affairs LPA) or over your health and welfare (if you are making a Health & Welfare LPA).

     

    You may include legally binding restrictions or conditions on how your Attorney(s) should make decisions. However, you are not required to do so.

     

    N.B. Inclusions of restictions or conditions can prevent flexibility. Where there are restrictions or conditions, an order from the Court of Protection may be necessary for that decision to be made. This may delay the decision and will incur a court fee.

     

    Please refer to page 11 of the accompanying guidance notes for further information regarding this.

     

  • With regards to the interests of {clientName}

  • Do you want your Attorney(s) to be able to use the Property and Financial Affairs LPA ONLY when you lack capacity?*

  • With regards to the interests of {firstName372}

  • Do you want your Attorney(s) to be able to use the Property and Financial Affairs LPA ONLY when you lack capacity?*

  • Section 7

    Guidance for your Attorney(s)

  • You may include discretionary guidance for your Attorney(s) to assist them with making decisions on your behalf. Please refer to page 9 of the accompanying guidance notes for more details.

  • With regards to the interests of {clientName}

  • With regards to the interests of {firstName372}

  • Section 8

    Paying your Attorney(s)

  • PAYING YOUR ATTORNEYS

     

    Generally, family and friends would not expect to be paid, but they can recover out-of-pocket expenses paid on your behalf. If you have Professional Attorney(s), they will need to be paid for their services and this will be specifically set out in the LPA(s).

  • Please click here if you wish to pay your Attorney(s) fees*

  • Section 9 (Optional)

    NAMED PEOPLE - Notifying people of the registrations of the Power of Attorney

  • Please refer to the separate information provide on page 11 of the accompanying guidance notes.

  • Named People to notify with regards to the interests of {clientName}

  • Named People to notify with regards to the interests of {firstName372}

  • Section 10

    Certificate Provider - Details of who you wish to act as your chosen Certificate Provider

  • Jonathan Creasey has been authorised to act as a Certificate Provider and can complete this element of the application form. Or, if your choice of Certificate Provider is to be someone other than our preferred Legal Partners or one of our registered Advisers and is someone not recommended by ourselves, please provide details below of whom you would like your Certificate Provider to be.

  • With regards to the interests of {clientName}

  • *

  • CERTIFICATE PROVIDER CONFIRMATION

    Jonathan L. Creasey

    First Chapter Consultancy Limited

    8a The Gardens

    Broadcut

    Fareham

    Hampshire

    PO16 8SS

  • With regards to the interests of {firstName372}

  • *

  • CERTIFICATE PROVIDER CONFIRMATION

    Jonathan L. Creasey

    First Chapter Consultancy Limited

    8a The Gardens

    Broadcut

    Fareham

    Hampshire

    PO16 8SS

  • Declaration

    (and Signature)

  • I, {clientName}, the donor, confirm this document has been completed accurately and in accordance with my wishes. I further confirm I have read and understood the Guidance Notes and Glossary Terms and have sought/will seek legal advice for any areas that required clarification.

  • *

  • Signature Date*
     / /

  • I, {firstName372}, the donor, confirm this document has been completed accurately and in accordance with my wishes. I further confirm I have read and understood the Guidance Notes and Glossary Terms and have sought/will seek legal advice for any areas that required clarification.

  • *

  • Signature Date*
     / /
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