Notes to complete
This form should only be used where an access to funds is already in place and
additional joint withdrawers require to be appointed. The application should
be made by the person wishing to become the joint withdrawer. The existing
withdrawer(s) must be in agreement with the proposed appointment otherwise
the application cannot be approved.
If you require assistance to complete this form please contact the Office of the
Public Guardian (OPG) where staff will be happy to help. Applicants should
refer to the code of practice for access to funds when considering
making use of this scheme.
Section 1 requests details of the existing authority and
personal details of the applicants to become withdrawers.
Since an application relating to the same adult has
previously been authorised there is no requirement
to duplicate details of the other interested parties, for
example: nearest relative, primary carer etc. However, any
change of address or change of primary carer, for example,
must be notified to the Office of the Public Guardian.
Section 2 contains an undertaking and declaration which must be
read carefully by the applicant(s) who should all sign and date the
application form. The existing withdrawer(s) must also sign and date the
form to confirm their agreement to the application.
Section 3 requires to be completed by a countersignatory who must meet the
criteria as set out in the application form. This section does not apply where
the application is made by an organisation.
details of any
interested party to
the application have
changed this should
be shown in section
1.3 of the application