Declaration of Interest Form
Name: ………………………………………… Signature ………………………………………….
Occupation: …..………………………………. Employer: ………………………………………….
I have read the Circle Code of Conduct for Board and Committee members and confirm that the
following is a correct declaration of my interests at ...... ….. (insert date)
1) Are you or any of your close relatives/associates a director of, or directly concerned in the management of, any business trading for profit?
2) Do you, or any your close relatives/associates, have an interest in an organisation which either has, or is likely to, enter into a contract, arrangement or other transaction with Circle or its Group Partners?
3) A list of the Local Authorities in which Circle operates is attached to this form. Are you, or any of your close relatives/associates a member or officer of any of these LA’s?
4) Are you a member of staff, Board or committee member of any Housing Association?
5) A structure chart of the Circle Group is enclosed with this form. Are any of your close relatives/associates employed by any organisations within the Group?
6) Please list any conflicts of interest, or potential conflicts of interest, not covered above.
Please provide further details in the space provided or on a separate sheet if you have answered yes to any question above.
LOCAL AUTHORITES IN WHICH CIRCLE WORKS
Barnet Lambeth
Barking & Dagenham Lewisham
Basildon Luton
Birmingham Maldon
Bedford Merton
Braintree Milton Keynes
Breckland Mole Valley
Brent Newham
Broadland North Norfolk
Brentwood Norwich
Bournemouth Penwith
Brighton & Hove Peterborough
Cambridge Rochford
West Cambridgeshire Redbridge
Camden Rochford
Castlepoint Redbridge
Chelmsford Sevenoaks
Colchester Southend on Sea
Coventry South Cambridgeshire
Croydon South Norfolk
Dacorum St Albans
Ealing St Edmundsbury
East Hertfordshire Stevenage
Eastbourne Suffolk Coastal
Enfield Tendring
Epping Forest Three Rivers
Fenland Tower Hamlets
Forest Heath Thurrock
Great Yarmouth Tonbridge & Malling
Hackney Tunbridge Wells
Hammersmith & Fulham Uttlesford
Harrow Walsall
Haringey Waltham Forest
Harlow Watford
Havering Wandsworth
Hertsmere Wellington & Hatfield
Huntingdon Westminster
Ipswich
Islington
Kensington & Chelsea
Kings Lynn & West Norfolk
If you have any queries on how to complete the form, please contact Angela Firman on 01603 703804
Declaration of interest Guidance: Board and Committee members
Circle fully supports the National Housing Federation’s Code of Governance and has enshrined its principles in its own Code of Conduct for members. Each member is reminded of the need to:
· Ensure that their private or personal interests do not influence their decisions, and that they do not use their position to obtain personal gain of any sort.
· Be meticulous about declaring conflicts and refrain from taking part in discussion or debate where such a conflict exists.
Circle’s Probity Policy prohibits the payment or grant of a benefit to any Board member, or the close relative of a Board member, or to a business trading for profit of which a Board member is the principal proprietor. The term “benefit” includes the award of any commercial or employment contract, the grant of a tenancy or lease and the sale of property. Certain exemptions apply, but Board and Committee members should be aware of, and declare, any potential areas of conflict.
The Tenant Services Authority emphasises that a declaration of interest by itself is not enough. For example, even if you made a declaration saying that you were the principal proprietor of a firm trading for profit, we would remain prohibited from using the firm. This is why it is important for us to have accurate and up to date records.
Circle Anglia and each of the Group Partners is governed by its consititutional documents; i.e its Rules or Articles of Association. Board members agree to abide by the provisions contained therein upon commencement of their appointment. These constitutional documents contain guidelines relating to a person’s eligibility to act as a Board member. A copy of Group Partner Rules/Articles is available from the Company Secretariat.
All information disclosed will be held in the strictest confidence and used only for the purpose stated.
If you have any queries on how to complete the form, please contact Angela Firman on 01603 703804