Address: Reshit Çollaku Str., Tel. 0800 9999, Fax. 04 228-516, Web

ALBANIAN REPUBLIC
HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

Index no.

HIDAA

Year

Address: “Reshit Çollaku” Str., Tel. 0800 9999, Fax. 04 228-516, Web.

D E C L A R A T I O N

OF PERIODIC/ANNUAL

PRIVATE INTEREST

Of the public official that has the obligation to make a declaration of his/her private interests, his/her spouse and the adult children, in pursuance to Law no.9049 dated 10 April 2003 “On the declaration and audit of assets, financial obligations of the elected persons and certain public officials”, Law no.9367 dated 7 April 2005 “On the prevention of conflicts of interest in the exercise of public functions”, along with the amendments included in law no.9475 dated 9 February 2006 and in law no.9529 dated 11 May 2006.

A U T H O R I Z A T I O N

ON THE AUDIT OF THE DECLARATION OF INTEREST

Name / Father’s name / Surname
Function
Address of institution
Date of nomination at current function / Date of submitting the form

In persuance to point 5, article 14, law no.9367 dated 7 April 2005 "On the prevention of conflicts of interest in the exercise of public functions”,

A u t h o ri s e :

Signature

The High Inspectorate of Declaration and Audit of Assets, as well as other people authorized by the Representative Authority – Inspector General of HIDAA, to verify all subjects, public and private, in or outside the country, on the private interests and financial liabilities, that are under my name, the name of my spouse and the adult children.

I declare that the data disclosed in this declaration form is the truth and I have not declared anything that is not true.

Information on behalf of your help:

Pages from 1-7 of this declaration form shall be fulfilled by the public official, whereas pages from 8-12 shall be fulfilled from the spouse and adult children when they own assets separately.

The type of declaration form “Periodic/Annual declaration form”should be completed, every year, by the public official who is exercising a certain public function, including the cases when the public official has had an interruption from his function of less than one year.

The declaration form should be completed and submitted no later than31 March, every year.

You can find and submit “The declaration form of private interest” at the Representative Authority (Directory of Human Resources) of the institution where you exercise your public function and legal assistance may be provided for you, in case you may need it. For further information, feel free and contact the High Inspectorate of Declaration and Audit of Assetsand exactly “The Unit of the Public Relations, Representative Authorities and Public Officials”, in the following phone numbers 04 234918, 04 234904, 08009999.

The information disclosed in the declaration form may be released to the public in compliance with law.

According to article 22 of law no.9049 dated 10 April 2003, point 3, article 14 of law no.9367 dated 7 April 2005, family members, who, according to this law, do not have the obligation to make a declaration, should make a declaration of the assets of they own.

In the periodic/annual declaration form you should include: only the changes (increases or decreases) of the immovable properties and the real rights over them, movable properties, financial liabilities,other interests and the source of their creation,from the previous declaration until the 31st March of the declaration year.

When the family member has his/her own property devided and has not completed the declaration form before starting work, he/she shall complete it by specifying the assets and the sources of their creation up to December 31 of the prior year. This declaration may be completed in the declaration form before starting work in pages 8-12.

Sanctions:

Every violation of the obligations defined in this law by officials constitutes a disciplinary violation, regardless of criminal or administrative responsibility.

For failure to make the declaration on time and without any good cause, the official or related person, is punished by a fine up to 30.000 lekë.

Refusal to make a declaration, according to article 5 of law no.9049 dated 10 April 2003, entails the loss of function and punishment in conformity with the Criminal Code.

False declaration is considered a criminal offence and it is punished according to the legislation in power.

FAMLY MEMBERS OF THE PUBLIC OFFICIAL ACCORDING THE CIVIL STATE CERTIFICATE

Name / Father’s name / Surname / Birthday / Relation to the declarant / Marital Status
DECLARANT
Full address where you are registered in the Civil Office:
(Administrative Unit, No., Street, Apartment, no., Municipality/Commune )
Full address in case you live somewhere else:
Name, Surname, Signature

Information in this page is confidential.

ALBANIAN REPUBLIC
HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

A detailed description of the changes (increases and decreases) in: type, surface, location, time of action performance, value, either in lek or in foreign currency, shown in the documents you own, in case not owning the documents, provide the increased or decreased value, the part you own in every kind of asset, movable or immovable property, registered or not in the public registry offices, from the previous declaration until the 31st of December of the declaration year.
No. Description of the asset and the source of its creation Value in figures & words Part
in %
Name, Surname, Signature

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ALBANIAN REPUBLIC

HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

A detailed description of the annual income, as a result of payment or membership in the steering commissions, committees or any other performed activity that generates income for you, your spouse and the adult children. Provide the name of the institution, organization or activity that provided the income, address, no. of the public register, status, aim and function of the activity of the activity of the organization and/or the nature of your engagement. / The amount of the created income, either in lek or in foreign currency, from the previous declaration – until 31st Dec of the declaration year
(given in figures & words).
Name, Surname, Signature

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ALBANIAN REPUBLIC

HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

The financial obligations to legal and natural persons (loans, borrowings, school obligations etc.) that exist in or outside the country, that are not yet liquidated from the previous declaration until 31stDecember of the declaration year,as well as the obligation created during the declaration year. These obligations migh be of the public offical, his/her spouse and the adult children.
The relevant data of the financial obligations should be given in the confidential information, included in page no.6.

Provide the cause of obligation, total amount either in lek or in foreign currency, the exact date of having and liquidating the obligation (month/year), no. of contract and the basic interest.For bank loans total amount (principal+interest), time duration (month/year) and the monthly liquidation is required. / Liquidated amount from the prevoius declarationup to the 31st of Dec.of the declaration year
(given in figures & words) / Obligation circumstances up to
31st of Dec. of the declaration year.
(given in figures & words)
Principal amount +interest
Name, Surname, Signature

ALBANIAN REPUBLIC

HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

GIFTS AND PREFERENTIAL TREATMENT

A detailed description of the type of gift more than 10000 (ten thousand lek), as well as preferential treatments, from the previous declaration until 31st Dec of the declaration year. / Identity of the natural and legal person and the relation with the declarants. / Value of the gift/ preferential treatment in lek or in foreign currency
(given in figures & words).
A detailed description of the CONFIDENTIAL data related to; private interests, movable and/or immovable properties, registered or not in the public registry offices, financial liabilities, the identity of the lending or borrowing natural or legal person, name of the public and private institution, with which you have an interest relation. / No. of the public register,
No. of the notary contract,
date/month/year

Other data concerning the legal and natural person, including the trustee, that results to be related to the official who has the obligation to make a declaration:

Name, Father’s name, Surname of the natural person and/or name of the legal person. / Relation to the declarant / Types of private interest and their location.
Name, Surname, Signature
Mob. Phone. No.
Off. ph. no., Fax, E-mail.

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ALBANIAN REPUBLIC

HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

In reference to article 24 and 35 of the law no.9367, dated 7 April 2005, the circle of persons related to an official, in implementation of the prohibitions of case by case and continuous conflicts of interest, consists of the spouse, adult children (with or separated from their parents) and parents of the official and the spouse.

Name / Father name / Surname / Birthday / Relation to the declarant / Marital Status
Declarant
Spouse
Declarant’s Father
Declarant’s Mother
Spouse’s Father
Spouse’s Mother
1. / The son/daughter in the same civil certificate of the public official
2.
1. / The son/daughter not in the civil certificate of the public official
2.

When property of members of the family is divided and registered as such in the organs of the state or judicial administration, the declaration is submitted separately by each member of the family, with the property registered in his name, and joined to the declaration of the person who has the obligation to make the declaration, by completing pages from 8-12.

This table should be fulfilled only for the family members (spouse, adult children) when they own assets separately.

Name / Father name / Surname / Birthday / Relation to the declarant / Marital Status
Name, Surname, Signature

I declare that I have notified the spouse and adult

Children that own assets separately, whom:

Have fulfilled the declaration form

Have not fulfilled the declaration form

To be completed from the public official “Periodic/Annual”1

ALBANIAN REPUBLIC
HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

Index no.

HIDAA

Year

D E C L A R A T I O N

OF PRIVATE INTERESTS

Of family members that have the obligation to make a declaration, in conformity with article 22 of Law no.9049 dated 10 April 2003 and point 3, article 14 of Law no.9367 dated 7 April 2005, on the assets that any of the family members possesses separately.

The citizen ______, the spouse

Name, father’s name, surname adult children together with the parents

adult children separated from parents

of the public official ______.

Name, father’s name, surname, function

AUT H O R I S A T I O N

ON THE AUDIT OF THE DECLARATION OF INTEREST

In persuance to point 5, article 14 of law no.9367 dated 7 April 2005 "On the prevention of conflicts of interest in the exercise of public functions”,

A u t h o r i s e :

The High Inspectorate of Declaration and Audit of Assets and the people authorized by the Representative Authority – Inspector General of HIDAA, to verify all subjects, public and private, in or outside the country, on the private interests and the financial liabilities, that exist under my name.

Name, Surname, Signature

I declare that the data disclosed in this declaration form is the truth and I have not declared anything that is not true.

Information on behalf of your help:

The type of declaration form “Annual/Periodic” shall be completed every year (including cases when there was a work relation interruption for less than one year) by family members that have the legal obligation to make a declaration of their private interest based in article 22 of the law no.9049, dated 7 April 2005 and article 14,point 3 of the law no.9367, dated 7 April 2005, when property of members of the family is devided and registered separately by any family member, the spouse and the adult children (separated or not by family certificate).

The declaration form should be completed and submitted no later than31 March, every year.

In the periodic/annual declaration formyou should include: only the changes (increases or decreases) of the immovable properties and the real rights over them, movable properties, financial liabilities,other interests and the source of their creation,from the previous declaration until the 31st March of the declaration year.

When the family member has his/her own property devided and has not completed the declaration form before starting work, he/she shall complete it by specifying the assets and the sources of their creation up to December 31 of the prior year. This declaration may be completed in the declaration form before starting work in pages 8-12.

The information disclosed in the declaration form may be released to the public in compliance with law.

Sanctions:

Every violation of the obligations defined in this law by officials constitutes a disciplinary violation, regardless of criminal or administrative responsibility.

For failure to make the declaration on time and without any good cause, the official or related person, is punished by a fine up to 30.000 lek.

Refusal to make a declaration, according to article 5 of law no.9049 dated 10 April 2003, entails the loss of function and punishment in conformity with the Criminal Code.

False declaration is considered a criminal offence and it is punished according to the legislation in power.

FAMILY MEMBERS OF THE ADULT CHILDREN NOT IN THE CIVIL CERTIFICATE OF THE PUBLIC OFFICIAL THAT OWNS ASSETS SEPARETELY

Name / Father name / Surname / Birthday / Relation to the declarant / Marital Status
Full address where you are registered in the Civil Office:
(Administrative Unit, No., Street, Apartment, no., Municipality/Commune )
Full address in case you live somewhere else:
Name, Surname, Signature

Information in this page is confidential

ALBANIAN REPUBLIC

HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

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Name, Surname, Signature
Mob. Phone. No.

ALBANIAN REPUBLIC

HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

Engagements in private activity for the purpose of rpofit or any kind of activity that creates income, as well as engagements in profit making and non profit organizations, syndicates or professional, political or state organizations and every other organisation; for the period of time from the date of the prevous declaration to 31st December of the declaring year.
In cases of passive ownership of shares and/or parts of capital, the right of benefiting the onwership civil fruits, that has been accomplished, shall be declared from the date of the privious declaration to 31st of the December of the declaring year.

The financial obligations to legal and natural persons (loans, borrowings, school obligations etc.) that exist in or outside the country, that are not yet liquidated from the previous declaration until 31stDecember of the declaration year,as well as the obligation created during the declaration year. These obligations migh be of the public offical, his/her spouse and the adult children.
The relevant data of the financial obligations should be given in the confidential information, included in page no.12.

ALBANIAN REPUBLIC

HIGH INSPECTORATE OF DECLARATION AND AUDIT OF ASSETS

A detailed description of the CONFIDENTIAL data related to; private interests, movable and/or immovable properties, registered or not in the public registry offices, financial liabilities, the identity of the lending or borrowing natural or legal person, name of the public and private institution, with which you have an interest relation. / No. of the public register,
No. of the notary contract,
date/month/year

Other data concerning the legal and natural person, including the trustee, that results to be related to the official who has the obligation to make a declaration:

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To be completed from family members with divided assets “Periodic/Annual”1