Please complete with details of the person GIVING the power :-

Full Name
Full Address
Home Phone
Work Phone
Mobile Phone
FAX
E-mail

Now give details of the person(s) being GIVEN the Power :-

First Attorney

Full Name
Address
Home Phone
Work Phone
Mobile Phone
FAX
E-mail

Second Attorney (Optional)

Full Name
Address
Home Phone
Work Phone
Mobile Phone
FAX
E-mail

Do you wish your Attorney(s) to do everything on your behalf ? Yes   No If "No", please answer the following additional questions.

Sell my  property at
Operate my Bank account at
Manage/Let and collect rent from my property at
Collect my pension from

Please list any restrictions you wish to place on the Power of Attorney

Is the person GIVING the Power capable of reading it, or does he/she need it read to them ? Yes, can read       No, cannot read.

    or