Fillable Declaration Form (Office of the Public Guardian)

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Declaration Form (Office of the Public Guardian)

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Adults with Incapacity (Scotland) Act 2000
Electronic Power of Attorney - Attorney Declaration Form
Name of Granter
Reference Number (if applicable)
Title of Attorney
Name of Attorney
House number / name
Street
Town
Postcode
Telephone number
Email Address
Type of Powers
(tick whichever applies)
Continuing
Welfare
Both
1. Your Duties and Responsiblities as Attorney
Please ensure you have read and understood the following important points. If you are unsure
whether you are, or are not, able to comply with any of the requirements below, please report this to the
person who has sent you this form.
• You must respect the general principles of the Adults with Incapacity (Scotland) Act 2000,
found in section 1.
• You should consult and respect the Code of Practice for Continuing and Welfare Attorneys
• If called upon to act, you must ensure that every measure is taken to support the granter of this
power of attorney to make their own decision on any matter, or otherwise to allow them to
exercise their legal capacity.
• You must ensure that any decision made on behalf of the granter respects their rights, will and
preferences and takes account of any known wishes and feelings, past or present.
• You must communicate with relevant parties and take account of their views.
• You must act within the scope of the powers granted to you.
• You must keep appropriate records.
• You are in a position of trust and must not take advantage of that position.
For more information about your duties and responsibilities as attorney, please refer to the Office of the
Public Guardian website and to our attorney factsheet.
2. Declaration by Attorney
I confirm by signing below that:
• I am over the age of 16 and willing, freely, to accept the appointment of attorney.
• I am not currently declared bankrupt (continuing attorneys only). For the purposes of the Adults
with Incapacity (Scotland) 2000 Act, a person is bankrupt if their estate has been sequestrated
for insolvency or a protected trust deed has been granted. Bankruptcy makes a continuing
appointment invalid but does not affect a welfare appointment.
Signature
Date
The Office of the Public Guardian reserves the right at any time to ask for evidence that the appointed
attorney is prepared to act.
Once completed this declaration should be retained by the sender of the power of attorney for their records.
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Declaration Form (Office of the Public Guardian)

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Completed 16 July 2020

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