Your Representative. You must appoint a representative who, irrespective of other responsibilities, will be responsible for your participation in our certification scheme, liaison with our assessment team and ensure your compliance with this agreement.
Your Representative. We acknowledge and you agree that you have appointed Wealthify Limited as your Representative (as defined herein) for the purpose of these Terms. You agree that your Representative is authorised by you to bind you to these Terms, to give us instructions and Orders on your behalf (on which we may act and rely under these Terms), and to perform all obligations and to exercise all rights required or entitled to be performed by or for you (as the case may be) under these Terms. All references to you in these Terms shall therefore automatically include a reference to your Representative. Please be aware that in most day to day business all your dealings with us will be through your Representative. However, in unusual circumstances, such as in the unlikely event of your Representative becoming insolvent, for example, you will need to deal with us directly under these Terms.
Your Representative. Title: Mr/Mrs/Miss/Other …………. Surname … … … … … … … … … … … … … … … … First names…………………………………………………… Relationship to the applicant: ………………………… … … Address ………………………………………………………………………………………………………………… ………………………………………………………………… Postcode … … … … … … … … … … Telephone……………………….Mobile………………….Email address………………………………… If Yes, Please tick which is applicable and attach the appropriate legal documentation. Power of Attorney 🞎 Enduring/Lasting Power of Attorney 🞎 Deputy/Receiver 🞎 If No, please tick if you are in the process of applying to the Office of Public Guardian or the Court of Protection 🞎 Solicitor (if applicable). Name & Firm…………………………………… … … … … … … … … … … … … … … … … … Address……………………………………………………………………………………………………… Postcode………………………………………… Telephone……………………………….. Email………………………………………………………………………… Name of Care Home … … … … … … … … … … … … … …… … … … … … … … … … … … Address……………………………………………………………………………………………………… ……………………… ………………… Postcode … … … … ………………………………… Telephone Number ………………………… Email address … … … … … … … … … … … … … The date you started living there on a permanent basis… /..…./……….. The date you would like the Deferred Payment to start… /..…./……….. (If your application is successful this is the date that KCC will pay the care home from, on your behalf) What is the total cost of your care home? £… per week
