Appointment

I, , residing at , appoint , residing at to be my

continuing attorney (my Attorney) in terms of section 15 of the Adults with
Incapacity (Scotland) Act !!! (which act and any subse"uent amendment of
that is referred to as the Act)# I declare that I intend that this power of
attorney shall be a continuing one which shall continue to ha$e effect e$en if I
shall ha$e lost capacity in relation to the matters in this deed#
General Powers
%y Attorney may manage my whole affairs as my Attorney thin&s fit and shall
ha$e full power for me and in my name or in his'her own name as my Attorney
to do e$erything regarding my estate which I could do for myself and that
without limitation by reason of anything contained in this power of attorney or
otherwise#
(ithout pre)udice to these general powers my Attorney shall ha$e the set
powers set out in the following clauses#
Particular Financial Powers
%y Attorney shall ha$e the following powers*
1# +o open, close, operate, any account containing my funds including
those held in common with other persons#
# +o claim and recei$e on my behalf all pensions, benefits,
allowances, ser$ices, financial contributions, repayments, rebates
and the li&e to which I may be entitled#
,# +o sign and endorse any che"ues, deposits, receipts or ban& drafts
issued and to be issued in my name or made payable to me#
-# +o sign and deli$er deeds and documents#
5# +o ma&e all ta. returns and ad)ust and settle any claim for ta.#
/# +o be allowed financial information concerning me#
0# +o re"uire disclosure to my attorney of any document or information
regarding me, howe$er confidential, including testamentary
documents#
1# +o pay my household e.penses#
2# +o effect, pay the premiums on, alter or surrender any insurance
policy#
1!# +o buy, lease, sell and otherwise deal with any interest I may ha$e in
property of any &ind or description and where$er situated#
11# +o buy, sell or lease and otherwise deal with heritable property (land
and buildings) on my behalf#
1# +o borrow and grant security for any sum and to pay the interest and
capital on any loan ta&en out by me or my Attorney on my behalf#
1,# +o recei$e or renounce any testamentary or other entitlements3 to
grant 4eeds of 5o$enant or ma&e any other pro$ision for my estate3
to set up any form of +rust#
1-# +o pay for pri$ate medical care and residential care costs#
15# +o pay any debt or claim owing by or to me#
1/# +o raise, defend, compromise and settle any court action and
enforce any decree#
10# +o ma&e, settle, compromise, discharge and refer to arbitration, any
claim
11# +o ma&e gifts on behalf of me, including any limits on the si6e of
such gifts or the potential recipients#
12# +o run, sell or wind up any business belonging to me#
!# +o pay for me to go on holiday and for the e.penses of any
accompanying carer'carers#
1# +o purchase out of my income or capital, a $ehicle or any other
e"uipment which may be re"uired for my benefit#
# +o employ 7an&ers, 7ro&ers, Solicitors 5ounsel, Accountants,
%anagers, 8actors or Agents of any &ind for the management of any
of my affairs at the usual professional rate of payment#
,# +o implement such ta. planning or similar arrangements as my
Attorney may deem suitable#
-# +o incur e.penditure on behalf of others as, in the )udgement of my
Attorney, acting reasonably, I myself would ha$e done if consulted or
able to be consulted3 including e.penditure for any children or other
dependants of mine#
Validity of documents
All documents which may be granted by my Attorney to whate$er person or
persons shall be e"ually $alid and binding as if granted by me#
Recall
+his power of attorney shall remain in e.istence until it is recalled by me in
writing or until my death#
Testing Clause
+his document is e.ecuted as follows*9
99999999999999999999999 9999999999999999999999999999
Signature of (itness Signature of :ranter
9999999999999999999999
full name of witness (print)
999999999999999999999999 9999999999999999999999999999
(address of witness) date of signing
999999999999999999999999 99999999999999999999999999999
place of signing
999999999999999999999999
S5;<4=>< 1 ?egulation
5<?+I8I5A+< =@4<? S<5+IA@S 15(,)(c) A@4'A? 1/(,)(c) A8
+;< A4=>+S (I+; I@5ABA5I+C (S5A+>A@4) A5+ !!! +A 7<
I@5A?BA?A+<4 I@ A 4A5=%<@+ :?A@+I@: A BA(<? A8
A++A?@<C
1. This certificate is incorporated in the document subscribed by
Insert name of granter
2. On
Insert date subscribed
3. That confers a
Tick appropriate box tick one box only
5ontinuing power of attorney (i#e# confers property or financial powers
only)
(elfare power of attorney (i#e# confers welfare powers only)
5ombined power of attorney (i#e# confers both property or financial
and welfare powers)
4 Appointing as Attorney!s"
Insert name(s) of Attorney(s)
5. #eclaration of Certifier
Note: any person signing this certificate should not be the person to whom
this power of attorney has been granted
I certify that
1
#
I inter$iewed the granter immediately before he'she subscribed
this power of attorney3

#
I am satisfied that, at the time this power of attorney was granted,
the granter understood its nature and e.tent3 and
I ha$e satisfied myself of this*
!lease tick appropriate box ("oth may apply but one must
apply)
(a) because of my own &nowledge of the granter3
and$or
(b) because I ha$e consulted the following person who has
&nowledge of
the granter on the matter
Insert name# address and relationship with granter# of
person consulted
,
#
I ha$e no reason to belie$e the granter was acting under undue
influence or that any other factor $itiates the granting of this power
of attorney#
Signed* ###########################################################
Brint name* #####################################################
Brofession* #####################################################
Address* #########################################################
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4ate* ###############################################################