Mandate - Easy Read - Carers of East Lothian

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:

Name(Required)

First Last

Address(Required)

(Full address incl postcode)

National Insurance Number

(We need this to support you in relation to benefits claims/financial entitlement. If you choose not to give us this information, it will limit our ability to provide this support.)

Date of birth(Required)

Day

Month

Year

Are you signing the Mandate on behalf of someone else?

Yes

Do you have power of attorney?

Yes

Are you their guardian?

Yes

Are you their DWP Social Security Scotland appointee?

Yes

Signed(Required)

Date(Required)

Day

Month

Year

Print name(Required)

Name

This field is for validation purposes and should be left unchanged.

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.

Importance Notice

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.

Tel: 0131 6650135

Mandate – Easy Read

Privacy Notice

Importance Notice