Mandate - Carers of East Lothian

I authorise Carers of East Lothian (CoEL) to act on my behalf and correspond with any relevant third party, including the Department of Work & Pensions, Social Security Scotland, Local Authorities, Medical Professionals, or any other Government department to pursue enquiries on my behalf and also to receive information from them in relation to:

my financial or benefit matters
my medical condition
my support needs

I understand this will be discussed with me prior to CoEL contacting any of the above mentioned third parties. I agree to third parties providing CoEL with any information they request on my behalf. I also understand that CoEL will maintain a record of this and other personal information while supporting and assisting me and I give my consent to them so doing.

Name(Required)

First Last

Address(Required)

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 appointee

Social Security Scotland appointee

Signed(Required)

Date(Required)

Day

Month

Year

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.

Phone

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