Are you acting on behalf of a member?

If you're acting on behalf of a member (for example, next of kin or power of attorney), please use the form below to get in touch with LPPA.

Only complete this form if you’re acting on behalf of a member.

Your full name*

Member email address*

Phone Number*

Are you authorised on behalf of the member?*

Your full name*

Member date of birth (UK-format: DD/MM/YYYY)*

Member National Insurance number (Enter the first 7 characters only)*

Message*

Characters remaining: 1000

Upload your files here (combined maximum 15MB). Photos or documents must be clear and readable.

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I have read and agree to the LPPA terms and conditions

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