Fill - Free fillable Atf 7---transition Of Authority (Office of the Public Guardian) PDF form

ADULTS WITH INCAPACITY

(SCOTLAND) ACT 2000

Transition of Authority

ATF(7)

Notes to complete

Application Form

OFFICE OF THE PUBLIC GUARDIAN (SCOTLAND)

Organisations - Fitness to Access Funds

ATF(1) – Request Account information

ATF(2) - Access to Funds

ATF(3) - Additional Joint Withdrawers

ATF(4) - Reserve Withdrawer

ATF(5) - Variation of Transactions

ATF(6) - Renewal of Authority

Other application forms

available in this series:

Notes to complete

this Form

This form should only be used where there is a financial guardian in terms of

Part 6 of the Adults with Incapacity (Scotland) Act 2000 and you wish to apply

for recall of that guardianship in favour of an application for access to funds

where:

(a) the guardian proposes to become the withdrawer, or

(b) someone other than the guardian proposes to become the withdrawer

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.

Provided the Public Guardian is satisfied that the adult’s property and

financial affairs can be safeguarded or promoted other than by guardianship,

an application for access to funds may be granted once the guardianship is

recalled. The former financial guardian or any other person may apply to be the

withdrawer.

Section 1 relates to the recall of the powers of the financial guardian

and requests details of the existing authority and details of any

disagreement identified after consultation with appropriate

interested parties to the guardianship. The financial guardian

must sign and date this section.

Section 2 requests details of the proposed withdrawer and

details of any identified joint/reserve withdrawers. In section

2.1 – Details of the proposed withdrawer: individual(s)

should complete the part marked (Individuals Only)

while organisations should complete the part

marked (Organisations Only).

Where personal

details of interested

parties have

changed this should

be shown in sections

2.5 to 2.9 of the

application form.

Since an application for guardianship has been previously granted relating

to the same adult there is no requirement to duplicate details of the adult

or other interested parties, for example, nearest relative, primary carer etc.

However, where personal details of such persons have changed this should

be shown in sections 2.4 to 2.9 of the application form.

If the guardianship has been in existence for some time the applicant should

provide full details to ensure that the Public Guardian’s records accurately

reflect the position.

Section 3 requests financial information. The applicant must identify the

account which is to be used as the current account in section 3.1 and confirm

any direct debits/standing orders which are to remain on this account in

section 3.2. Failure to do the latter will result in existing direct debits/standing

orders on that account being stopped once the certificate is lodged with the

bank/building society. A second account, if in existence, should be identified

in section 3.3.

In section 3.4 the applicant must identify the anticipated ongoing monthly

expenditure required to meet the adult’s financial needs and complete

the section appropriately. Banks/Building Societies etc normally deal with

financial matters in monthly periods consequently this is the period considered

as best suited in this application form. Care costs are sometimes calculated in

four weekly periods so some adjustment would be required. If, however, this

does not suit the adult’s particular needs you may wish to discuss this with

staff at this office.

Identifying on-going expenditure is a reasonably straightforward process

similar to that probably used in your own household budgeting. The aim is to

ensure that the day to day and on-going living expenses can be paid from the

income/funds held in the account and/or savings.

This section of the form is designed in a way that it covers most of the normal

monthly costs such as utility bills, mortgage or rent, council tax etc. There

is also a part for any other expenditure under the heading “other - please

specify”. It is not always possible to have a distinct heading for every

eventuality and where an expected expenditure does not fit into the categories

shown it should be identified as other and needs to be specified, eg personal

spending money. Use the examples provided below as a guide to completion

of this part of the form.

Example 1: If the adult pays rent, currently payable at £100 monthly and

calculated at £1,200 in year one (£100 x 12 months), you may wish to allow

£1,360 to cover potential increase in year two and possibly £1,580

for year three. This would total £4,140 over the period of three

years. Therefore you may wish to request £115 per month

(£4,140 divided by 36 months) for rent in your application

form. You should apply the same logic in terms of each

heading.

Example 2: If the adult is in a care home and costs are

currently payable at £250 weekly that would work out at

£13,000 in year one (£250 x 52 weeks). If you estimate that

costs might go up by approximately 10%, in year two you

might expect the annual cost to be £14,300 and in year three

this figure might be £15,730. So over the three year period you

may require £43,030. This could be rounded up to £43,200 to cover

the full three years, which divided by 36 (months) would be £1,200

monthly.

As indicated above the amounts requested do not need to be exact but it

is important to ensure that there will be sufficient money in the designated

account to make sure the adult is provided for by using his or her funds. Over

estimating, within reason, will not be seen as detrimental to the adult. The

Public Guardian may request to see some form of evidence of anticipated

expenditure, for example, utility bills, care home invoices etc as part of the

application process.

The Public Guardian may apply a degree of flexibility in that anything which

is seen to be reasonable and appropriate does not necessarily have to be

supported by invoice or other form of evidence. However, the Public Guardian

reserves the right to request further information or evidence when considering

an application.

The access to funds process also allows a one off lump sum to be requested.

This should be identified at section 3.5 if required. This is generally used

where there has been a build up of costs due to the account not being

accessible and debts building up which require to be paid. The example

shown over demonstrates how this can be done.

Remember to build

in a gure in your

calculations to cover

ination as shown in the

examples opposite.

Example: An adult may have been in a home for a period of four months

before the application is considered. If the care home costs were £2,000 per

month this would build up a debt due of some £8,000 (£2,000 x 4 months).

It normally takes four weeks to fully process an application to access funds

therefore you should also request a further £2,000 to cover the debt which will

continue to accrue until the certificate of authority is issued allowing you to

pay off this debt. Therefore the lump sum request in this example should be

£10,000.

The cost of the application and any costs associated with obtaining the

medical certificates may be identified as part of the lump sum and can then

be reimbursed through the designated account once the lump sum is

paid therein.

A lump sum request might look as follows:

Outstanding care costs £10,000

Underpayment of council tax £ 250

Medical certificate from Doctor £ 100

OPG registration fee £ 60

Total Lump Sum request £10,410

Generally where a lump sum is requested the Public Guardian will expect to

see evidence of its purpose in the form of an invoice or similar. In the example

shown above the Public Guardian would expect to see an invoice relative to

the outstanding care costs; council tax and the doctor’s fee note.

The period of authority is normally set at three years but may be extended or

reduced dependent on the needs of the adult and the level of funds available.

If the period is to be other than three years the reason for such should be

clearly identified in section 3.7 of the application form.

When a new certificate of authority is granted it will only provide authority to

carry out the transactions requested in this application form. If there is any

other action required which was not dealt with during the original period of

authority it requires to be highlighted in section 3.8 of the application form.

Section 4 identifies that a copy of the application will be sent to the adult and

other persons named in the original and/or in the application.

Because the adult

cannot read or

understand the content

of a document does

not constitute or pose a

serious risk to health.

Where the applicant considers that a copy of the application should not be

sent to the adult as it would pose a serious risk to the adult’s health,

the applicant should tick the box. Medical Certificate SSI No 79

requires to be completed where the applicant considers that a

copy of the application should not be sent to the adult. The

section Medical Certificates in the code of practice for access

to funds provides further information.

Section 5 contains an undertaking and declaration which all

withdrawers require to sign and date. Where the proposed

withdrawer is not the previous guardian section 6 requires

to be completed.

Section 6 of this form only requires to be completed by a

countersignatory, where it is proposed to appoint a new joint

withdrawer or reserve withdrawer not previously identified. In all

other instances this section should not be completed. The countersignatory

must meet the criteria as set out in the application form. This section does not

apply where the application is made by an organisation.

The Public Guardian needs to confirm that the condition of the adult still

meets the criteria as set in Section 1(6) of the Act. The medical certificate SSI

No 76 enclosed at the rear of this form must now be completed by a medical

practitioner and accompany your application. This should be done before

signing or having the application form countersigned. The application form

must be lodged with the Public Guardian within 14 days of the date of the

countersignatory signing the application form where required, or within 14

days of the applicant signing the form. The section Medical Certificates in the

guidance notes for access to funds provides further information.

Use the checklist located near the end of the application form to ensure

you have completed all the information requested and thereafter send your

application to the Public Guardian.

A fee is payable for this application and cheques should be made

payable to the “Scottish Court Service”. Details of current fees

can be obtained form the OPG or from our website.

Office of the Public Guardian (Scotland)

Hadrian House

Callendar Business Park

Callendar Road

FALKIRK, FK1 1XR

DX: 550360 Falkirk 3

LP: LP-17 Falkirk

Telephone: 01324 678300

Fax: 01324 678301

Email: opg@scotcourts.gov.uk

Website: www.publicguardian-scotland.gov.uk

The office of the Public Guardian (OPG) is open to the public from

9am to 5pm, Monday to Friday.

This leaflet is available free of charge in Braille, audiotape

large print format, and various non-English languages by phoning

the above telephone number. The OPG subscribes to Language Line

and the RNID Typetalk service.

ATF (7) 1 /22

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









I hereby apply for the financial powers in the guardianship order to be recalled because another less

intrusive measure other than guardianship, namely access to funds scheme, could satisfactorily safeguard

the interests of the adult.



In making this decision I have consulted the adult; primary carer; nearest relative and all other persons

that the sheriff has said must be consulted. They agree/disagree (delete as appropriate) to the proposed

action. Where there is a disagreement please specify the reason and by whom below:

SIGNATURE OF GUARDIAN FOR RECALL:

PRINT NAME:

DATE:

ADULTS WITH INCAPACITY







ATF (7) 2 /22



Where more than one withdrawer is proposed, details should be identified in section 2.2 as joint

withdrawers.

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

Please identify relationship to the adult: (If family member please state exact relationship)

Please answer the following questions deleting YES or NO as appropriate and follow the instructions given.

Is the proposed withdrawer the:

Nearest Relative If No complete Section 2.5

Primary Carer If No complete Section 2.6

Named Person If No complete Section 2.7

Attorney/Guardian If No complete Section 2.8



Is it intended that the current guardian be the withdrawer?

If Yes, go to section 2.2 If No, complete section 2.1

ATF (7) 3 /22



Organisation:

Department:

Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Organisation List Number:

Nominated Contact for Organisation

Surname:

Forename:

Middle Name:

Contact Person’s Designation:

Tel No:

E-Mail Address:

ATF (7) 4 /22

Use separate page if necessary.

Please identify relationship to the adult: (If family member please state exact relationship)

Please answer the following questions deleting YES or NO as appropriate and follow the instructions given.

Is the proposed withdrawer the:

No 1 No 2

Nearest Relative If No complete Section 2.5

Primary Carer If No complete Section 2.6

Named Person If No complete Section 2.7

Attorney/Guardian If No complete Section 2.8



Is it intended that there be joint withdrawer(s)?

If Yes, complete below If No, go to section 2.3

Joint Withdrawer (1) Joint Withdrawer (2)

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

ATF (7) 5 /22

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

Please identify relationship to the adult: (If family member please state exact relationship)



In the guardianship order made by the court the adult’s details were provided. There is no requirement to

provide this information again, however, if for any reason, their details have changed for example, change

address, and the Public Guardian has not been notified please advise changes below:





Is it intended that a reserve withdrawer be identified at this time? A reserve withdrawer can be applied for

at a later time if required using form ATF(4).

If Yes, complete below If No, go to section 2.4

ATF (7) 6 /22



The nearest relative of the adult may be a spouse, brother, sister, son or daughter of the adult or some

other more distant relative. If the applicant is the nearest relative there is no need to complete this section.

In certain circumstances any person claiming an interest on behalf of an adult with incapacity may ask a

sheriff to make an order which will stop certain information being given to the nearest relative. In making

such an order, the sheriff will have named another person to act as the nearest relative. This will only be for

the purpose of any application made in terms of this Act. This person may be another relative for example,

a nephew or niece or somebody else such as a friend or neighbour.

In the guardianship order made by the court the nearest relative’s details may have been

provided. You are not required to complete this section unless the details of the nearest

relative have changed.

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

If there has been a Court Order naming the above as the nearest relative to the adult please tick this box

Please answer the following questions deleting YES or NO as appropriate and follow the instructions given.

Is the nearest relative the:

Primary Carer If No complete Section 2.6

Named Person If No complete Section 2.7

Attorney/Guardian If No complete Section 2.8

ATF (7) 7 /22

Title:

Surname:

Forename:

Middle Name:

Name of Organisation: (if applicable)

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

Please identify relationship to the adult: (If family member please state exact relationship)

Please answer the following questions deleting YES or NO as appropriate and follow the instructions given.

Is the primary carer the:



The primary carer is the person who has day to day responsibility to look after the needs of the adult.

If the adult is in hospital or a care home etc you should identify the primary carer as being the manager or

officer in charge of the ward, care home or other establishment.

In the guardianship order made by the court the primary carer’s details may have been

provided. You are not required to complete this section unless the details of the primary

carer have changed.

Named Person If No complete Section 2.7

Attorney/Guardian If No complete Section 2.8

ATF (7) 8 /22



A named person is someone who, in terms of the Mental Health (Care and Treatment)(Scotland) Act 2003,

has powers and rights to represent and safeguard the adult’s interests.

In the guardianship order made by the court the named person’s details may have been provided. You

are not required to complete this section unless the details of the named person have changed.

Does the adult have a named person?

If Yes, complete below If No or not known, go to section 2.8

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

Please identify relationship to the adult: (If family member please state exact relationship)

Please answer the following question deleting YES or NO as appropriate and follow the instructions given.

Is the named person the:

Attorney/Guardian If No complete Section 2.8

ATF (7) 9 /22



A continuing attorney includes a reference to a person granted, under a contract, grant or appointment

governed by the law of any country, powers (however expressed) relating to the granter’s property or

financial affairs and having continuing effect notwithstanding the granter’s incapacity.

A welfare attorney includes a reference to a person granted, under a contract, grant or appointment

governed by the law of any country, powers (however expressed) relating to the granter’s personal welfare

and having effect during the granter’s incapacity.

Guardian includes a reference to a guardian (however called) appointed under the law of any country to,

or entitled under the law of any country to act for, an adult during his incapacity, if the guardianship is

recognised by the law of Scotland.

In the guardianship order made by the court the attorney or guardian’s details may have been provided.

You are not required to complete this section unless the details of the attorney or guardian have

changed.

Does the adult have an attorney or guardian?

If Yes, complete below If No or not known, go to section 2.9

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

ATF (7) 10 /22



Any other interested party is any other person who has not already been identified in the application and

who has an interest in the adult’s affairs. This may be other relatives or partners.

In the guardianship order made by the court the details of any interested parties may have been

provided. You are not required to complete this section unless such details have changed.

Use separate page if necessary.

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

Now go to Section 3

ATF (7) 11 /22



Branch Name:

Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Sort Code:

Name of Account Holder:

Account Number:





Please provide full details about the adult’s existing account which you wish to access. This account will be

referred to as the adult’s current account.





Detail existing standing orders/direct debits set up on this account which you wish to continue or identify

those which you wish to set up on this account. Please note that any existing standing orders/direct debits

on this account not identified here will cease to be paid when you commence to access the adult’s funds.



In addition to the adult’s current account it is possible to identify an existing account in the adult’s sole

name which will be known and operated as the adult’s second account. It may be that some funds would

benefit from being placed into this second account.

Name of Company to whom payment

Amount payable monthly £

is to be made for example, Scottish Power etc.

Continue:

Set Up:

ATF (7) 12 /22

Reason for Expenditure Monthly Amount £

Gas

Electricity

Telephone (inclusive of mobile phones and special telephone services)

Mortgage

Rent

Insurances (building, contents, motor, personal, pets etc)

Council Tax

TV Licence

Care Charges

Loan Repayments

Club or other subscriptions

Food and household expenses

Clothing

Holidays/Outings

Transport costs

Other (Please specify)



If the adult already has a bank account in his/her sole name which you would wish to operate as a second

account provide details below:



This section should be completed giving full details of all funds required.

Before completing this section it is important to refer to the accompanying notes to complete this

application form. This will tell you how to calculate the anticipated expenditure and what supporting

evidence may be required.



Branch Name:

Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Sort Code:

Name of Account Holder:

Account Number:

0.00

ATF (7) 13 /22



The access to funds process not only allows for regular ongoing expenses to be taken but also allows for a

one off lump sum to be requested. This is generally used where there has been a build up of costs due to

the adult’s funds not being accessible and debts building up which require to be paid. Before completing

this section it is important to refer to the accompanying notes to complete this application form. This will

tell you what supporting evidence is required.

Do you require a lump sum?

If Yes, complete below

If No, go to section 3.7

Reason for Expenditure Amount £

One off payments/lump sums (Please specify)





If the lump sum requested is to be transferred from the adult’s current account please leave this section

blank, otherwise identify the account from which the lump sum is to be transferred.



Branch Name:

Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Sort Code:

Name of Account Holder:

Account Number:

0.00

ATF (7) 14 /22



A certificate of authority is normally valid for a period of three years. If you wish the certificate to be valid

for a period other than that you must state the period you require and the reason below:



If you propose to carry out any other additional financial transactions please provide details below:

ATF (7) 15 /22





A copy of this application will be sent to the adult and other persons identified in the original application

and/or this application. If you consider that a copy of the application should not be sent to the adult as it

would pose a serious risk to the adult’s health please tick the box.

Simply to indicate that the adult would not understand the application or would be upset by it is not

sufficient grounds for non intimation.

If you have ticked the above box the Public Guardian will require you to lodge with this application a

medical certificate (in the form of SSI No 79) completed by two medical practitioners. A copy of form SSI

No 79 is enclosed.





I understand that it is my responsibility to keep records of the exercise of my powers as withdrawer and

notify the Office of the Public Guardian directly and immediately of any change of circumstances involving

any party identified in this application for example, change of address or death of the adult etc.

I undertake to:

a) open a designated account solely for the purpose of receiving funds transferred under the authority of

any certificate granted to me and intromitting with those funds; and

b) operate any accounts in the sole name of the adult as directed by my certificate of authority.



I declare that all information contained in this application is true and correct to the best of my knowledge

and I understand that false or misleading information may lead to the rejection of this application or the

termination of any authority already granted.

I confirm that the Office of the Public Guardian is authorised to contact appropriate bodies as it sees fit in

order to seek such information as they consider reasonable in pursuance of this application.

ATF (7) 16 /22





The Office of the Public Guardian will retain and process the information provided herein on computer. This

processing is necessary for the exercise of the statutory functions conferred on the Public Guardian by the

Adults with Incapacity (Scotland) Act 2000. By signing below I understand that I consent to this information

being processed, stored and used by the Office of the Public Guardian in the discharge of its function.

SIGNATURE OF PROPOSED

WITHDRAWER:

PRINT NAME:

DATE:

SIGNATURE OF ANY OTHER

PROPOSED WITHDRAWER(S):

PRINT NAME(S):

DATE:

The Public Guardian needs to confirm that the condition of the adult still meets the criteria as set in section

1(6) of the Act. The medical certificate (SSI76) enclosed at the rear of this form must now be completed by

a medical practitioner and accompany your application. You should arrange to have the medical certificate

completed before you or the countersignatory, if appropriate, sign and date this application.

Once completed this application must be lodged with the Public Guardian within 14 days of the proposed

withdrawer and any other withdrawers signing and dating the application form.

Please note that where joint withdrawers or a new reserve withdrawer are identified in this application you

require to have section 6 completed before lodging the application with this office.

ATF (7) 17 /22



This section does not require to be completed where the guardian applying for recall of powers is to be

the withdrawer.

The countersignatory must read the full application form and agree to its content and be satisfied that this

application is necessary before completing and signing the declaration.

The countersignatory must read the declaration thoroughly and ensure that he/she meets the criteria

as set. If not, that person cannot act as countersignatory in this application. If there are new joint

withdrawers/reserve withdrawer and you cannot find one countersignatory who meets the criteria for all

you require a separate countersignatory to support each withdrawer. Each countersignatory must fully

complete a separate section 6.

The countersignatory must declare if he or she is liable to gain financially from involvement in this

application and if so the countersignatory must identify the nature and extent in the box provided. A

monetary or financial interest is known as a “pecuniary interest”.



Title:

Surname:

Forename:

Middle Name:

House Name:

House Number:

Street:

Locality:

City:

County:

Country:

Post Code:

Tel No:

E-Mail Address:

Please note that the Public Guardian may at some time during this process contact the

countersignatory in relation to the application.

ATF (7) 18 /22







• for at least one year prior to the signing of the foregoing application and I believe the proposed

withdrawer(s) to be a fit and proper person(s) to intromit with the adult’s funds. I further believe that

the information contained in this application to be true.

• I am not :

(a) a relative or person residing with the proposed withdrawer(s) or the adult; or

(b) a director or employee of the fundholder; or

relation to any matter under this Act; or

(d) the medical practitioner who has signed the medical certificate in connection with this application; or

(e) a guardian of the adult or a welfare or continuing attorney of the adult; or

(f) a person who is authorised under an intervention order in relation to the adult.

Select (a) or (b) below

The nature and extent of that interest is:

(a) I have no pecuniary interest in this application.

(b) I have a pecuniary interest in this application.

ATF (7) 19 /22

The countersignatory must now complete this question providing as much relevant information as

possible.

Please comment below on how you feel that the proposed withdrawer is a fit and proper person and has

the ability to carry out the functions of withdrawer:

SIGNATURE OF COUNTERSIGNATORY:

PRINT NAME:

DATE:

This application form must be lodged with the Office of the Public Guardian no later than

14 days after the date the form is countersigned.

ATF (7) 20 /22





























Save Form

Print Form

Reset Form

ATF (1) 17 /18

Scottish Statutory Instrument 2008 No. 51

(Previously SSI No. 76)

Regulation 3

Adults with Incapacity (Scotland) Act 2000 (“the Act”)

Certicate of incapacity to accompany an application to the Public Guardian under section

24C, 24D or 25

I ……………………………………………………............…………………...........…….……………....(Full Name)

of ……………………………………………….………………......................…….……..........................................

(Professional Address) in my capacity as .....................................................................................................

(1)

have examined the following patient on ……….…………...................................................……..……...(Date),

... ……………………………………………………..…............…..........………………………….(Patient’s Name)

of …………………................................................................................………………..…………………………..

…………………………..…………………….................…....(Address) ............./............/............ (Date of Birth)

I am of the opinion that he/she is incapable in relation to decisions about, or incapable of acting to

safeguard or promote his/her interests in, his/her funds.

I am of the opinion that the patient named above is incapable in terms of section 27B of the Act

because of:

mental disorder

(2)

and/or

inability to communicate because of physical disability

(3)

Brief description of mental disorder/inability to communicate ……….....................................………

……………………………………………………………………………....................................…………

……………………………………………………………………....................................…………………

(Signed) ……………….....................………………………..

(Date) ……………………….....................………………….

(1) the person signing the certicate must be a medical practitioner; insert as appropriate, eg GP,

specialist in mental disorder.

(2) mental disorder has the meaning given to it in section 328 of the Mental Health (Care and

Treatment) (Scotland) Act 2003, namely that it means any mental illness; personality disorder or

learning disability however caused or manifested, but an adult is not mentally disordered by reason

only of sexual orientation; sexual deviancy; transsexualism; transvestism; dependence on, or use

of, alcohol or drugs; behaviour that causes, or is likely to cause, harassment, alarm or distress to

any other person; or acting as no prudent person would act.

(3) one of these must be deleted unless both apply.

ATF (1) 18 /18

SCOTTISH STATUTORY INSTRUMENT 2001 No 79

Adults with Incapacity (Scotland) Act 2000 (“the Act”)

Evidence to inform decision to dispense with notication to adult with incapacity in terms of Sections 7(1)(d)

and 11(2) of the Act.

IMPORTANT: This form is to be completed by two medical practitioners.

A: First Medical Practitioner:

I ………………………………………………..........…………………………............……………..…....(Full Name)

of …………………………………………………………………...............…........…….......(Professional Address)

have examined the following patient on ……….…………….................................…..(Date), in my capacity as

…………………………………………………………………..........……..…..............………………………………*

to ……………….…………………………………………….............…………..........…………….(Patient’s Name)

…………………...........……(Date of Birth), of ………………………..……............………………….……………..

…………………………..…………………….…………….............…………….........………....(Patient’s Address)

I am of the opinion that it would pose a serious risk to the health of the patient named above for the Public

Guardian to notify him/her of an application under Section 26 of the Act for authority to intromit with funds.

The reason for this opinion is ……………………………...............................……………………………………...

……………………………………………………………...................................……………………………………...

………………………………………………….....….(Signed) …………..........…...................………………(Date)

B: Second Medical Practitioner:

I ………………………………………………………………………..........……............…………..…....(Full Name)

of ……………………………………………….…………...................................................(Professional Address)

have examined the following patient on ……….……………...…...................….….....(Date), in my capacity as

……………………………………………………..……………........……..............……………..……………………*

I am of the opinion that it would pose a serious risk to the health of the patient named above for the Public

Guardian to notify him/her of an application under Section 26 of the Act for authority to intromit with funds.

The reason for this opinion is…………………………………………......................………………...……………...

……………………………………………………………….........……………..............……………………………….

…………………………………………….………….(Signed) ………………..……................................…(Date)

* the person signing the certicate must be a medical practitioner; insert as appropriate, eg GP, specialist in

mental disorder

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Email completed PDF

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Email for others to sign

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Atf 7---transition Of Authority (Office of the Public Guardian)

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