Barclays Form – Fill Out and Use This PDF

How are the Attorney(s) appointed?

Select how the Attorney(s) have been appointed.

Sole – only one Attorney appointed

Jointly/Together – Two or more Attorneys appointed, who must act together

Jointly & Severally/Independently – Two or more Attorneys appointed, who can act independently of each other

Number of Attorneys

How many Attorneys are appointed in the Power of Attorney document?

One Two Three Four

Details of 1st Attorney

Title: Mr Mrs Miss Ms

Other

First name Middle Name(s) Surname Date of birth Address

Postcode Nationality

Second Nationality (if dual nationality is held)

Access Options

What access to the Donor’s account(s) is required by the Attorney?

Note – the services below are not available where the Attorneys have been appointed on a Joint/Together basis.

Telephone Banking? Yes No

Please note – for a Barclays direct investing account you must request telephone banking in order to access the account.

Details of 2nd Attorney

Title: Mr Mrs Miss Ms

Other

First name Middle Name(s) Surname Date of birth Address

Postcode Nationality

Second Nationality (if dual nationality is held)

Access Options

What access to the Donor’s account(s) is required by the Attorney?

Note – the services below are not available where the Attorneys have been appointed on a Joint/Together basis.

Telephone Banking? Yes No

Please note – for a Barclays direct investing account you must request telephone banking in order to access the account.

Details of 3rd Attorney

Title: Mr Mrs Miss Ms

Other

First name Middle Name(s) Surname Date of birth Address

Postcode Nationality

Second Nationality (if dual nationality is held)

Access Options

What access to the Donor’s account(s) is required by the Attorney?

Note – the services below are not available where the Attorneys have been appointed on a Joint/Together basis.

Telephone Banking? Yes No

Please note – for a Barclays direct investing account you must request telephone banking in order to access the account.

Details of 4th Attorney

Title: Mr Mrs Miss Ms

Other

First name Middle Name(s) Surname Date of birth Address

Postcode Nationality

Second Nationality (if dual nationality is held)

Access Options

What access to the Donor’s account(s) is required by the Attorney?

Note – the services below are not available where the Attorneys have been appointed on a Joint/Together basis.

Telephone Banking? Yes No

Please note – for a Barclays direct investing account you must request telephone banking in order to access the account.

Use this form to tell us whether or not the donor is mentally capable of managing their own financial affairs.

Attorneys may wish to seek legal advice or to contact the Office of the Public Guardian before signing

this Declaration.

I/We the attorney(s) refer to the Lasting Power of Attorney made by:

Donor’s Name:

Donor’s Address:

Dated (date LPA was set up) and registered with the Office of the Public Guardian on

(date).

A copy of the Lasting Power of Attorney is attached/ already held by the Bank (please delete as appropriate).

Please tick the appropriate option below, then read the relevant declaration before signing this form:

Donor is not mentally capable of managing their own financial affairs (Please read Declaration A and delete where appropriate)

Donor is mentally capable of managing their own financial affairs (Please read Declaration B and delete where appropriate)

Declaration A: Donor is not mentally capable of managing their own financial affairs

1.I/We confirm that the Donor is (in accordance with the provisions of the Lasting Power of Attorney) currently unable to manage their financial affairs and operate their Bank account(s).

2.I/We understand that the Bank will write to the Donor to advise that I/we have signed this Declaration.

3.I/We agree to inform the Bank if the Donor becomes able to manage their financial affairs and operate any of their bank accounts at any time in the future.

4.I/We understand that the Bank will generally no longer accept instructions from the Donor.

5.I/We understand that if the Donor disputes this Declaration the Bank might only allow payments from the Donor’s accounts on the joint instructions of the Donor and me/us and that any such dispute might need to be referred to the Office of the Public Guardian.

6.I/We certify that to the best of my/our knowledge I/we have complied with my/our duties imposed on me/us under the Lasting Power of Attorney.

Declaration B: Donor is mentally capable of managing their own financial affairs

1.I/We confirm that the Donor is able to manage their financial affairs and operate their Bank Account(s).

2.I/We as Attorney(s) agree to inform the Bank if the Donor again becomes in accordance with the provisions of the Lasting Power of Attorney unable to manage their financial affairs and operate their Bank Account(s).