[{"id":"f8eb99f4-3265-4012-b4e8-53a0e7d87b35","order":1,"text":"THIS DEED OF","fontSize":"11","textAlign":"center","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true,"marginTop":"20"},{"id":"a5416121-7703-479f-8973-305195488ed6","order":2,"text":"LASTING POWER OF ATTORNEY","fontSize":"22","textAlign":"center","bold":true,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"6fa1e1ae-57dd-43f8-beaf-0d1a305ee3bb","order":3,"text":"(HEALTH AND WELFARE)","fontSize":"16","textAlign":"center","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"bd3e654c-42fa-4802-bc52-f598020f4f42","order":4,"text":"Made pursuant to sections 9 to 14 and Schedule 1 of the Mental Capacity Act 2005","fontSize":"11","textAlign":"center","bold":false,"underline":false,"marginBottom":"40","cflou":false,"active":true},{"id":"92040ce8-5d01-450b-b8b2-0c1de04852f7","order":5,"text":"THIS LASTING POWER OF ATTORNEY is granted on this [date of execution] by:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"43758376-a9c8-474a-8316-921fa66d3349","order":6,"text":"[Title] [First name(s) of the Donor] [Surname of the Donor], born on [Date of birth], of [Address], [Town/City], [Postcode] (hereinafter referred to as the «Donor»).","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"548e9294-4c6e-4b5e-b15b-c5faa3ee2de1","order":7,"text":"PART 1 — PURPOSE AND SCOPE","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S01"},{"id":"286afb66-6573-4a03-af08-80c72f0b84d5","order":8,"text":"By executing this Deed, the Donor confers upon the Attorney(s) hereinafter appointed a Lasting Power of Attorney in respect of decisions concerning the Donor's personal welfare, including but not limited to decisions relating to medical treatment, healthcare, place of residence, social care arrangements and any other matter touching upon the Donor's health or welfare.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"e0f02027-de95-4dbf-ac40-4bc3355f6718","order":9,"text":"This Lasting Power of Attorney is granted in accordance with section 9 of the Mental Capacity Act 2005 and shall be exercisable only at such time as the Donor lacks capacity to make the relevant decision, in accordance with section 11(7)(a) of the said Act.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"793bc3e2-ecd1-43b3-bb37-544555628e0b","order":10,"text":"The Donor hereby acknowledges that the Attorneys are under a duty to act in the Donor's best interests pursuant to section 4 of the Mental Capacity Act 2005, and to have regard at all times to the Code of Practice issued under that Act.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"4f97dd7a-56e7-4721-9623-3e7450a319de","order":11,"text":"PART 2 — APPOINTMENT OF ATTORNEYS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S02"},{"id":"826395ef-4f3d-4cba-9461-862c4ac4c396","order":12,"text":"The Donor hereby APPOINTS the following person to act as the Donor's Attorney for health and welfare:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"3","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"4","type":"remove","operator":"="}]},{"id":"87119dde-5498-4ab5-be61-08d4ddb611c1","order":13,"text":"The Donor hereby APPOINTS the following persons to act jointly as the Donor's Attorneys for health and welfare:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="}]},{"id":"289d4484-f7b1-49aa-84e0-c9273e881c56","order":14,"text":"Attorney 1:","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"5","cflou":false,"active":true,"marginTop":"10"},{"id":"f36e45bc-238b-4d63-8495-ba2fc8d8d039","order":15,"text":"[Title] [First name(s)] [Surname], born on [Date of birth], of [Address], [Town/City], [Postcode].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"50da68ce-cdc2-457e-845e-4aed86840298","order":16,"text":"Attorney 2:","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="}],"marginTop":"5"},{"id":"8d4bc07a-3994-45a3-8c1e-7eff8cb4dfa9","order":17,"text":"[Title] [First name(s)] [Surname], born on [Date of birth], of [Address], [Town/City], [Postcode].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="}]},{"id":"f21b035d-0894-4c5b-af84-83f56be0879b","order":18,"text":"Attorney 3:","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="}]},{"id":"dc0579b3-8e8e-4dcc-ace8-0c0f581eea8f","order":19,"text":"[Title] [First name(s)] [Surname], born on [Date of birth], of [Address], [Town/City], [Postcode].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="}]},{"id":"db0a8d8a-0f54-42f6-a62e-5f4d8c60469b","order":20,"text":"Attorney 4:","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"3","type":"remove","operator":"="}]},{"id":"f5a4dc63-cdc4-4d43-a1aa-6dfb9deb1281","order":21,"text":"[Title] [First name(s)] [Surname], born on [Date of birth], of [Address], [Town/City], [Postcode].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"3","type":"remove","operator":"="}]},{"id":"20167ae8-a982-4d28-a289-3076abd3211e","order":22,"text":"PART 3 — MANNER IN WHICH THE ATTORNEYS SHALL ACT","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="}],"marginTop":"20","sectionNum":"S03"},{"id":"4db68693-f58a-43d2-9f98-bf84710e5a9e","order":23,"text":"The Attorneys shall act jointly and severally, meaning that they may exercise the powers conferred by this Deed either acting together or independently of one another. Any decision taken by any one Attorney acting alone shall bind the Donor as if taken by all of them.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly for some decisions, and jointly and severally for other decisions","type":"remove","operator":"="}]},{"id":"8728001a-e2ec-4c0f-8d37-85dc91abb248","order":24,"text":"The Attorneys shall act jointly, meaning that every decision made under the authority conferred by this Deed must be agreed upon unanimously by all Attorneys then willing and able to act. No Attorney may act alone.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly and severally","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly for some decisions, and jointly and severally for other decisions","type":"remove","operator":"="}]},{"id":"5ed927e5-b237-49b3-8344-34cd2e592059","order":25,"text":"The Attorneys shall act jointly for some decisions and jointly and severally for others. The following categories of decision must be taken unanimously by all Attorneys then willing and able to act; in respect of all other matters within the scope of this Deed, the Attorneys may act either together or independently:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly and severally","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly","type":"remove","operator":"="}]},{"id":"d8915f3a-f26e-4b6d-805d-9968a6808b64","order":26,"text":"[Specify the categories of decision requiring unanimous agreement.]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly and severally","type":"remove","operator":"="},{"field":"381afd7c-6109-41a7-96d0-73cd4c46d204","value":"jointly","type":"remove","operator":"="}]},{"id":"86992201-a831-4b24-83fb-fa2ac8f85825","order":27,"text":"PART 4 — REPLACEMENT ATTORNEY","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a4565a49-1d83-4f2f-9fa9-d8f8f6e38b4d","value":"No","type":"remove","operator":"="}],"marginTop":"20","sectionNum":"S04"},{"id":"856eb553-3704-4b33-9274-d00e7272c9ff","order":28,"text":"The Donor hereby APPOINTS the following person as Replacement Attorney, to take the place of any of the original Attorneys appointed under Part 2 above who is unable or unwilling to act, whether by reason of death, mental incapacity, disclaimer, bankruptcy or otherwise:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a4565a49-1d83-4f2f-9fa9-d8f8f6e38b4d","value":"No","type":"remove","operator":"="}]},{"id":"e6821f5b-e7f9-4952-ae8e-4fc5aab90f29","order":29,"text":"[Title] [First name(s)] [Surname], born on [Date of birth], of [Address], [Town/City], [Postcode].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a4565a49-1d83-4f2f-9fa9-d8f8f6e38b4d","value":"No","type":"remove","operator":"="}]},{"id":"b397d454-35b3-4ffe-944f-8c62ea0ecf8c","order":30,"text":"Upon assuming office, the Replacement Attorney shall enjoy all the powers, and be subject to all the duties, conferred and imposed upon the original Attorneys by this Deed and by the Mental Capacity Act 2005.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a4565a49-1d83-4f2f-9fa9-d8f8f6e38b4d","value":"No","type":"remove","operator":"="}]},{"id":"5f7014dc-d3be-4f1d-a4db-bdc54b9252b8","order":31,"text":"PART 5 — LIFE-SUSTAINING TREATMENT","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S05"},{"id":"19627eb3-d761-4523-9a36-5a1339d053fe","order":32,"text":"Pursuant to section 11(7) and (8) of the Mental Capacity Act 2005, the Donor hereby makes the following express provision in respect of life-sustaining treatment, that is to say treatment which, in the view of a person providing healthcare to the Donor, is necessary to sustain the Donor's life:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"a21b3055-b354-4eb9-b867-5ff15bcd2691","order":33,"text":"I give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf.","fontSize":"15","textAlign":"center","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"47a13d9b-8e66-454d-9a99-308765f01a2b","order":34,"text":"Accordingly, the Attorneys shall have authority, when acting in the Donor's best interests in accordance with section 4 of the Mental Capacity Act 2005, to give or to refuse consent on the Donor's behalf to the giving, continuation or withdrawal of any treatment which a healthcare professional considers necessary to sustain the Donor's life.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a1aaa2ef-864e-4c9e-a6bd-c4b95a48a2b9","value":"I do not give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf","type":"remove","operator":"="}]},{"id":"c064169c-7da3-4d4a-83da-59ce58475336","order":35,"text":"Accordingly, the Attorneys shall have NO authority to give or to refuse consent on the Donor's behalf to life-sustaining treatment. All such decisions shall be taken by the treating healthcare professionals in the Donor's best interests pursuant to section 4 of the Mental Capacity Act 2005.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a1aaa2ef-864e-4c9e-a6bd-c4b95a48a2b9","value":"I give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf","type":"remove","operator":"="}]},{"id":"f20b87aa-adfb-40e9-9944-48d468c14c40","order":36,"text":"PART 6 — PREFERENCES","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"95972152-cbf6-4335-9735-12115c81ee87","value":"No","type":"remove","operator":"="}],"marginTop":"20","sectionNum":"S06"},{"id":"15579f6b-b70e-40bd-9e4d-f13fd0c441d5","order":37,"text":"The Donor expresses the following preferences. These are not legally binding upon the Attorneys but the Attorneys are expected to give them serious consideration when making decisions on the Donor's behalf:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"95972152-cbf6-4335-9735-12115c81ee87","value":"No","type":"remove","operator":"="}]},{"id":"a7127459-b640-4a46-a75d-7761fec09931","order":38,"text":"[Preferences of the Donor]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"95972152-cbf6-4335-9735-12115c81ee87","value":"No","type":"remove","operator":"="}]},{"id":"b1e24574-8c4e-4880-9c17-7aa570e70ab1","order":39,"text":"PART 7 — INSTRUCTIONS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"2d30df90-66f7-4ecd-80d8-bff7b78f865f","value":"No","type":"remove","operator":"="}],"marginTop":"20","sectionNum":"S07"},{"id":"6c98fd5b-a251-4cf8-8da2-b7de04285e2f","order":40,"text":"The Donor gives the following binding instructions to the Attorneys, which the Attorneys are obliged to follow in the exercise of the powers conferred by this Deed, save in so far as compliance would be unlawful or contrary to the Donor's best interests as determined under the Mental Capacity Act 2005:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"2d30df90-66f7-4ecd-80d8-bff7b78f865f","value":"No","type":"remove","operator":"="}]},{"id":"92e7e2d9-17e1-4529-a6c3-9ba829a4b739","order":41,"text":"[Instructions of the Donor]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"2d30df90-66f7-4ecd-80d8-bff7b78f865f","value":"No","type":"remove","operator":"="}]},{"id":"6f44144f-1f9e-46d1-a135-4eb71c4700a8","order":42,"text":"PART 8 — PERSON TO BE NOTIFIED","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"7c334364-5cd9-4023-9726-85d70db9e0f9","value":"No","type":"remove","operator":"="}],"marginTop":"20","sectionNum":"S08"},{"id":"c284f8f6-b6d5-40ac-b198-ffd6ccfff2f0","order":43,"text":"The Donor nominates the following person to be notified by the Office of the Public Guardian upon any application being made to register this Lasting Power of Attorney:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"7c334364-5cd9-4023-9726-85d70db9e0f9","value":"No","type":"remove","operator":"="}]},{"id":"332bf1a9-cafa-4220-8e3d-2ca69efbfd94","order":44,"text":"[Title] [First name(s)] [Surname], of [Address], [Town/City], [Postcode].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"7c334364-5cd9-4023-9726-85d70db9e0f9","value":"No","type":"remove","operator":"="}]},{"id":"3f106426-57c6-48a2-aad6-ee065455b50b","order":45,"text":"PART 9 — DECLARATION BY THE DONOR","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S09"},{"id":"7e72f4b9-a221-42e9-94ff-f3cfe15deba9","order":46,"text":"The Donor hereby declares that:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"32f28b5e-4cf3-4e89-acfa-f5d40f18e435","order":47,"text":"(a) The Donor has read this Lasting Power of Attorney in its entirety and understands the nature, effect and scope of the authority hereby conferred;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"29fd8dbf-00df-4262-ac8c-87755eeda852","order":48,"text":"(b) The Donor wishes the Attorneys named in Part 2 above (and, if applicable, the Replacement Attorney named in Part 4) to have authority to make decisions on the Donor's behalf in respect of personal welfare, including the decisions referred to in Part 5;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"872e14c0-e9a2-466e-89c9-871c31d46f81","order":49,"text":"(c) The authority conferred by this Deed shall come into effect, and may be exercised, only at such times as the Donor lacks capacity to make the decision in question, in accordance with section 11(7)(a) of the Mental Capacity Act 2005;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1a435d2f-f83b-4cb9-bdc5-16072b691793","order":50,"text":"(d) This Deed cannot be used to make any decision in respect of property or financial affairs, for which a separate Lasting Power of Attorney for Property and Financial Affairs would be required;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"217b72b0-fc0a-487d-8b80-3d1f3859a296","order":51,"text":"(e) The Attorneys are bound to act at all times in accordance with the principles set out in section 1 of the Mental Capacity Act 2005, in the Donor's best interests under section 4 of that Act, and in accordance with the relevant Code of Practice;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"5ab26476-e661-4d26-b8cd-df62c8d98bce","order":52,"text":"(f) This Deed shall have no legal effect until it has been duly registered with the Office of the Public Guardian in accordance with the provisions of the Mental Capacity Act 2005 and regulations made thereunder.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"95190d9c-4ce4-40d1-a695-93929a7a0f66","order":53,"text":"PART 10 — EXECUTION BY THE DONOR","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S10"},{"id":"a4ffeffa-58c7-494c-9efa-f5a128be47e3","order":54,"text":"SIGNED as a deed by the Donor, [Title] [First name(s)] [Surname], at [Place of signing] on this [date of execution], in the presence of the witness whose signature appears below:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"bfaa58b4-582a-46dd-b29b-9f3738a87762","order":55,"text":"Signature of the Donor: ___________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"1e847a94-4eae-44cc-bdb9-42e222eb14a3","order":56,"text":"Witness's signature: ___________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"4ddff686-6918-4a72-b20e-69e0bf100a34","order":57,"text":"Witness's full name (in block capitals): ___________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"7284ced1-d419-4a00-bc21-73a51b869f93","order":58,"text":"Witness's address: ___________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"cab6e13a-908b-46d2-81a1-29bf56bca764","order":59,"text":"Note: the witness to the Donor's signature must be over the age of 18 and must not be one of the Donor's Attorneys or Replacement Attorneys. The witness must observe the Donor signing the deed.","fontSize":"11","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"e2f34b44-12d7-4c46-b11b-4d58c3d0cde6","order":60,"text":"PART 11 — CERTIFICATE BY AN INDEPENDENT THIRD PARTY","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S11"},{"id":"37be478f-576e-4637-b054-5f1ffa429d5b","order":61,"text":"(Pursuant to paragraph 2(1)(e) of Schedule 1 to the Mental Capacity Act 2005)","fontSize":"11","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"4c3ddb87-83fe-466b-a233-e89ff54b816c","order":62,"text":"I, [Title] [First name(s)] [Surname], of [Address], [Town/City], [Postcode], HEREBY CERTIFY that:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"4b8d2c4f-658c-4a0b-a082-b5d186ab45b3","order":63,"text":"I am acquainted with the Donor, [Title] [First name(s)] [Surname], having known the Donor personally for a period of at least two years.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"76559dbf-7119-4922-95ed-8c20a561cd27","value":"professional","type":"remove","operator":"="}]},{"id":"0f23b765-f456-4cc4-b375-54b7889810c2","order":64,"text":"I am qualified to provide this certificate by virtue of my professional skills and expertise, being a [Profession], and I have used my professional skills to assess the Donor's understanding of this Lasting Power of Attorney.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"76559dbf-7119-4922-95ed-8c20a561cd27","value":"personal","type":"remove","operator":"="}]},{"id":"cea97fd5-fb1c-4d15-8da8-f1de055cbf66","order":65,"text":"I FURTHER CERTIFY that:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"9ce60d3b-8f53-4d33-afef-43a3e8d1a472","order":66,"text":"(a) The Donor understands the purpose of this instrument and the scope of the authority conferred upon the Attorneys;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"c524cb66-4154-4f83-8408-f07b3caba573","order":67,"text":"(b) No fraud or undue pressure has been used, so far as I am aware, to induce the Donor to create this Lasting Power of Attorney;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1ef4862d-10dd-4aff-b39c-2bed5f9e86ca","order":68,"text":"(c) There is no other matter of which I am aware that would prevent this Lasting Power of Attorney from being created.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"9ed0370e-c11c-4e4d-a7a6-1f53bf04053d","order":69,"text":"SIGNED at [Place of signing] on this [date of execution] — (note: same date as Donor's execution).","fontSize":"11","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"4bbdfc8d-88d3-4808-aa4e-7137b136049b","order":70,"text":"Signature of the Certificate Provider: ___________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"d0f69830-d34f-4b7e-9e5d-6f91c2456184","order":71,"text":"PART 12 — STATEMENT AND EXECUTION BY THE ATTORNEYS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S12"},{"id":"be9ac0ce-1698-4267-8568-b84031d09c6b","order":72,"text":"Each Attorney appointed under this Deed (and, where applicable, the Replacement Attorney) hereby declares, by their signature below, that they:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"021f62e7-4885-45a9-8795-c4d7a38917ec","order":73,"text":"(a) Have read this Lasting Power of Attorney and understand the nature, effect and scope of the authority conferred upon them;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"dfee6b3f-8ee6-403b-9183-055b8bd0533c","order":74,"text":"(b) Understand and accept their duty to act at all times in the Donor's best interests in accordance with the Mental Capacity Act 2005 and the relevant Code of Practice;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"f66d083d-3ce2-4d89-96bf-6a59172409e7","order":75,"text":"(c) Understand that this Lasting Power of Attorney has no legal effect until registered with the Office of the Public Guardian.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"0207d1a2-4e94-488b-9cfa-fbfea88d5c9d","order":76,"text":"Attorney 1 — [Title] [First name(s)] [Surname]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"da6b982e-d174-47a1-8136-93d54b4d87b5","order":77,"text":"Signature: ___________________________________ Date: _______________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"45b0be1b-673a-4821-b7d3-1abb3ff06c6e","order":78,"text":"Witness's signature: _______________________ Witness's name: _______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"25","cflou":false,"active":true},{"id":"0b7fc96b-95e4-4d94-bceb-81c802d81e69","order":79,"text":"Attorney 2 — [Title] [First name(s)] [Surname]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="}]},{"id":"3a8de8b9-8bad-40f3-8029-1f5edeb3e9e9","order":80,"text":"Signature: ___________________________________ Date: _______________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="}]},{"id":"8a19ee55-65f9-4c64-bf06-0ed3744d45b2","order":81,"text":"Witness's signature: _______________________ Witness's name: _______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"25","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="}]},{"id":"fef50b3c-a4f9-45e5-a979-342146ba07cb","order":82,"text":"Attorney 3 — [Title] [First name(s)] [Surname]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="}]},{"id":"1de81354-66bf-453c-aa1e-e989140ca8b0","order":83,"text":"Signature: ___________________________________ Date: _______________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="}]},{"id":"c7102d50-738e-4af1-a4e0-05d725ecb3ad","order":84,"text":"Witness's signature: _______________________ Witness's name: _______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"25","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="}]},{"id":"dbcbc8b6-be7f-47e9-9f85-338c1096a0cf","order":85,"text":"Attorney 4 — [Title] [First name(s)] [Surname]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"3","type":"remove","operator":"="}]},{"id":"4f690c10-3704-4981-9c39-e3dc4cfedfc0","order":86,"text":"Signature: ___________________________________ Date: _______________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"3","type":"remove","operator":"="}]},{"id":"89e259d0-2883-4422-a0b0-f68e017bb6ac","order":87,"text":"Witness's signature: _______________________ Witness's name: _______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"25","cflou":false,"active":true,"displayConditions":[{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"1","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"2","type":"remove","operator":"="},{"field":"3c450ea3-faed-4b9f-b932-35cb247ed696","value":"3","type":"remove","operator":"="}]},{"id":"7583c2ed-a6f3-4b94-ba40-45f041d3d6bf","order":88,"text":"Replacement Attorney — [Title] [First name(s)] [Surname]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"a4565a49-1d83-4f2f-9fa9-d8f8f6e38b4d","value":"No","type":"remove","operator":"="}]},{"id":"ba7cd0af-6c80-4f32-9885-f89d6491e9bf","order":89,"text":"Signature: ___________________________________ Date: _______________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"a4565a49-1d83-4f2f-9fa9-d8f8f6e38b4d","value":"No","type":"remove","operator":"="}]},{"id":"5c268eac-d402-46f8-a4fa-5a0794c234fc","order":90,"text":"Witness's signature: _______________________ Witness's name: _______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true,"displayConditions":[{"field":"a4565a49-1d83-4f2f-9fa9-d8f8f6e38b4d","value":"No","type":"remove","operator":"="}]},{"id":"297147ce-da59-487d-af3f-6f20ce412771","order":91,"text":"Note: the witness to each Attorney's signature must be over the age of 18 and must not be the Donor. The same witness may attest the signature of each Attorney.","fontSize":"11","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"2588933b-937b-49dd-8e6f-4de21ab75c14","order":92,"text":"PART 13 — REGISTRATION","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20","sectionNum":"S13"},{"id":"7f285b0f-fa7a-4ba6-875d-ab0d6ccdd861","order":93,"text":"This Lasting Power of Attorney must be registered with the Office of the Public Guardian before it may be used. Application for registration may be made by the Donor or, with the Donor's knowledge, by any of the Attorneys. A registration fee is payable, subject to any applicable exemption or remission.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"89203185-b93e-413c-acb4-192de6e439c4","order":94,"text":"Until registered, no Attorney may exercise any of the powers conferred by this Deed. Registration is governed by sections 9(1), 10, and Schedule 1 of the Mental Capacity Act 2005 and by regulations made thereunder.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"053f2e6d-8b10-4dfb-8402-a4e47b952936","order":95,"text":"— END OF DEED —","fontSize":"12","textAlign":"center","bold":true,"underline":false,"marginBottom":"0","cflou":false,"active":true,"marginTop":"20"}]