Details of the person GIVING the power: Name Title Street address Address (cont.) City County Postal code Work Phone Home Phone FAX E-mail     Date of Birth DD/MM/YYYY     Is this person capable of reading the Power of Attorney,  does he/she need it read to them? Yes, can read No, cannot read. Details of person(s) BEING GIVEN the Power: a). First Attorney's Details: Name Title Street address Address (cont.) City County Postal code Work Phone Home Phone FAX E-mail b). Second Attorney's Details: Name Title Street address Address (cont.) City County Postal code Work Phone Home Phone FAX E-mail Type of the Power : Ordinary Power of Attorney Or Enduring Power of Attorney Restrictions on the Power: Do you wish to place any restrictions on the Power of Attorney.   Yes No If you answered with 'No' skip to next section If yes please continue with this question.  I wish to place the following restrictions on the Power of my Attorney: Effective date of general power: If an Enduring Power of Attorney. Do you want it to be effective immediately or Only when you become mentally incapable of managing your own affairs          Other information Please add any other information you think will help us Our charge for drawing a general Power of Attorney is £80.00 plus VAT of £14.00 (£94.00), What Happens Next We may need to contact you further whilst we prepare your Power of Attorney. The recent introduction of Money Laundering laws means we will need to see you in person and prove your identity. It may be possible for us to travel to you in certain circumstances, we will discuss this with you when we contact you further.