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I, ………………………………………………………., hereby declare my intention to transfer the powers I currently hold with regards to acting on behalf of myself, specifically in matters of property/law/finances/assets/family/etc., to DIPSOMANIA SOCIETY, who should henceforth be considered to be executors of my estate in my lifetime and thereafter. I do this now by solemnly and sincerely declaring as follows:-

1. THAT I AM OF SOUND MIND AND BODY ENOUGH TO BE AWARE OF MYSELF, MY SURROUNDINGS AND THE NAME OF THE CURRENT PRIME MINISTER OF THE UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND.

2. THAT I HAVE READ, UNDERSTOOD, AND NOW ACCEPT THE ABOVE PARAGRAPHS NUMBERED 1 – 8, BEING THE PARTICULARS OF THE WORKINGS OF THIS DEED TO POWER OF ATTORNEY.

3. THAT I AM SOLVENT

4. THAT NONE OF THE PROPERTY OR LAND BEING USED AS SECURITY FOR ANY MORTGAGE OR OTHER LENDING I AM CURRENTLY IN RECEIPT OF IS BEING CONSIDERED FOR ANY REASON BY ANY PARTY WHO IS NOT THE LENDER.

DECLARED THIS _____ DAY OF __________ IN THE YEAR ________________

BY …………………………………………
(Being the person noted throughout this document as “transferor”)
OF …………………………………………
(Being that person’s current residential address)

BEFORE ME …………………………………………
(Being a solicitor, requested by the above signed to explain this document and to witness the signing of the same)
OF ………………………………………… …………………………………
(Being the registered office of the above signed solicitor where he/she can be contacted by DIPSOMANIA SOCIETY for the purposes of officially recognising and identifying both signatures as they appear on this document, should this ever be required)

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