Hallett & Co Solicitors

Power of Attorney Questionnaire

Personal Details Title *
Full Name *
Address *
Post Code *
Date of Birth *

Date of Birth

Daytime Phone Number *
Mobile Number
Email Address *

Family Details Full name of spouse/partner
Partner's Date of Birth

Partner's Date of Birth

Child 1 Child's Full Name
Child's Date of Birth

Child's Date of Birth

Child 2 Child's Full Name
Child's Date of Birth

Child's Date of Birth

Child 3 Child's Full Name
Child's Date of Birth

Child's Date of Birth

Details of Attorney Attorney's Full Name
Attorney's Address
Attorney's Post Code
Their relationship to you

Details of Second Attorney Attorney's Full Name
Attorney's Address
Attorney's Post Code
Their relationship to you

Powers you wish to grant to the Attorney(s)

If you wish to appoint two attorneys do you want them to act together or independently of each other when dealing with your affairs?

Together

Independantly

Do you wish your attorney(s) to have general power to act on your behalf?

Yes

If no, what do you wish your Attorney(s) to do on your behalf?