Mandate - Carers of East Lothian

If you would find this form easier to understand in Easy Read format, you can use our Easy Read Mandate here.

Easy Read uses straightforward language and supporting images to help explain information.

This form should only be signed by someone able to understand and consent to it.

I authorise Carers of East Lothian (CoEL) to correspond with relevant third parties — including the Department for Work & Pensions, Social Security Scotland, Local Authorities, medical professionals, or any other government department — to make enquiries and receive information on my behalf about:

my financial or benefit matters
my medical condition
my support needs

This mandate does not give CoEL authority to make decisions on my behalf, or on behalf of the person I care for.

All decisions remain with me (or the cared-for person), or with anyone who holds Power of Attorney or Guardianship for that person. CoEL’s role is limited to making enquiries, receiving and sharing information, and supporting me to make my own decisions.

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Name(Required)

First Last

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Address

(Full address incl postcode)

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

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

If so, please indicate under what authority you are signing

Power of Attorney

Guardianship

DWP/ Social Security Scotland appointee

Signed(Required)

Date(Required)

Day

Month

Year

Print name(Required)

The consent given via this Mandate is valid for the period of 1 year.

Privacy Notice

By law, all organisations that use personal information (personal data) must provide a clear description of how it is used and also provide any related information to ensure the processing is carried out lawfully and fairly. CoEL’s main Privacy Notice is available on our website - www.coel.org.uk/privacy. We encourage you to read this, so you are fully informed of your personal data processing rights. Please contact 0131 665 0135 if you need alternative format such as print or braille. If you have any specific concerns regarding the processing of your personal data you can 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.

Disclaimer

Our organisation provides advice and advocacy based on information provided by the service user at the time of giving that advice. The service bases its advice on legislative information, case law and any other guidance currently available. Whilst every effort is made to ensure that advice given is accurate and up to date the organisation cannot accept any responsibility or liability for any inaccuracies or incomplete information.