Easy Read Mandate

I agree that Carers of East Lothian (CoEL) can work for me. They can communicate with any other person or organisation for me.

This includes the Department of Work & Pensions, Social Security Scotland, Local Authorities, Medical Professionals, or any other organisation that can help with:

my money or benefits

my medical condition

my support needs

I understand that CoEL will ask me before they contact anyone. I agree that people can give CoEL information about me.

I understand that CoEL will keep a record of this and other personal information while helping me. I agree to this.

I understand that this mandate will last for 1 year and that if another mandate is needed after 1 year, CoEL will ask me to complete another one.

Consent(Required)

I agree

Name(Required)

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

National Insurance Number

We need your National Insurance Number to help you with benefit claims. If you do not give this we may not be able fully support you.

Date of Birth(Required)

Are you signing the mandate for someone else?(Required)

Yes

Sometimes people are allowed to make decisions for other people. This is normally because they have Power of Attorney, they are their guardian, or they are their DWP Social Security Scotland appointee.

Do you have power of attorney?(Required)

Yes

Are you their guardian?(Required)

Yes

Are you their DWP Social Security Scotland appointee?(Required)

Yes

Signature(Required)

Date(Required)

Print name(Required)

Privacy Notice

The law says that organisations who use personal information must say how it is kept and used.

CoEL’s main Privacy Notice is available on our website – www.coel.org.uk/privacy. You should read this if you want to know about your privacy rights.

Please contact 0131 665 0135 if you need another format like large print or braille.

If you want to know more about how we use your information contact our Data Protection Manager:

Carers of East Lothian, East Lothian Community Hospital, Alderston Road, Haddington, EH41 3PF, email chiefexecutive@coel.org.uk or telephone 0131 665 0135.

Our organisation gives advice and advocacy. This is based on information we get from the service user.

Our advice is based on the law and other guidance that is available. We try to make sure our advice is right and up to date. We do not cannot accept responsibility if we are given wrong information.