Please complete all sections of this form. If you do not have an interest to declare, please enter NONE.
Note: You must enter information in every box. Spouse or Partner means your spouse, civil partner, or person with whom you live as husband or wife or civil partner, so far as you are aware of their interests.
Full Name
Year of Completion
Any employment, office, trade, profession or vocation carried on for profit or gain.
Myself
Spouse or Partner
Any payment or provision of any other financial benefit, other than from the Council, made within the last 12 months in respect of your duties as a member, or towards election expenses.
Any contract made between the Council and you, your spouse or partner, a firm in which either of you is a partner, or a body corporate in which either of you has a beneficial interest.
Any beneficial interest in land or property within Cliviger. This may include your home, land you own, occupy, rent, or receive income from.
Any licence, alone or jointly with others, to occupy land in Cliviger for one month or longer.
Any tenancy where the landlord is the Council and the tenant is a body in which you, your spouse or partner has a beneficial interest.
Any beneficial interest in securities, shares, bonds or similar holdings in a body which has a place of business or land in Cliviger, where the holding meets the relevant disclosure threshold.
I am a member of, or I am in a position of general control or management in:
Other Interests
Organisation
For example, a school governing body, another council, or a parish council.
Any body whose principal purposes include the influence of public opinion or policy, including political parties, trade unions and professional bodies.
You must declare any gift or hospitality received in your capacity as a member with an estimated value of £25 or more.
Gift or Hospitality Received, including estimated value
Received From
If you believe disclosure of an interest on a public register could lead to you, or a person connected with you, being subject to violence or intimidation, you should disclose this as a sensitive interest to the Monitoring Officer. Sensitive interests do not need to be published on this form.
Do you need to discuss any sensitive interests with the Monitoring Officer? NoYes
I understand that I must register my disclosable pecuniary interests and other interests. I understand that it may be a criminal offence under the Localism Act 2011 to fail to register a disclosable pecuniary interest, provide false or misleading information, or fail to update this information when my circumstances change.
I understand that I must notify the Monitoring Officer of any changes to my registered interests within 28 days of becoming aware of the change.
I confirm that the information provided is accurate to the best of my knowledge.
Type Full Name as Signature