Regionally Elected Councillor

Regionally Elected Councillor

Declarations Form

Two declarations are required. The first is a declaration of willingness to serve and the second is a declaration of material interests. The declaration of material interests will be lodged in the library for public view in the event of your election to Council. Each declaration must be signed separately.

These declarations must both be returned to the Constitutional

Affairs Secretary at the RIBA, 66 Portland Place, London, W1B 1AD

by 5.00 p.m. Friday 19 May 2017.

The following Chartered Member is a candidate for election as a Regionally Elected Councillor for RIBA ………………………..

Name(capitals): …………………………………………………………..

Membership No.: …………………………………..

Full contact details:……………………………………………………….

………………………………………………………………………………

Declarationof Willingness to serve

I confirm that I am willing, if elected, to serve as a Nationally Elected Member of the RIBA Council for a 3 year period starting in September 2017 and that I know of no legal reason why I would be ineligible to stand as a Councillor.

I confirm that I understand the fundamental duties and responsibilities of the RIBA Councillor as described in the Guidance documents andthat I will act in good faith in accordance with the law and within the policy and strategy of the RIBA.

Candidate’s signature: ……………………………...………….

Date: …………….………..……..… 2017

Please continue to the second declaration…./

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Declaration of material interests

Name in capitals……………………………………

Membership number…………………..

Declaration of material interests which are relevant to the business of the RIBA

Please record below, information about any material personal, business or other interests (including information relating to members of your family or friends) which might to the best of your knowledge and belief:

give rise to a conflict of interest for you with the interests of the RIBA or
influence your behaviour as a council member or the way in which you alone, or together with others, participate in, or vote on RIBA affairs whether in Council, on boards, committees or in any other capacity or
Lead to a perception of a conflict of interest in the eyes of the public.

Appointments paid or voluntary including but not limited to partnerships, trusteeships, directorships, or beneficial interest in companies, elected office in local government etc.

Membership of formal bodies, including but not limited to other professional bodies, political parties, special interest groups and mutual support organisations

Close professional or social relationships with individuals who have business relationships with the RIBA

Family members or partners and friends who have business relationships with the RIBA

Continued on next page……/

Current employment or previous employment in which you continue to have a financial interest

Any other conflicts of interest not covered by the above

I declare, to the best of my knowledge or belief, and in relation to my financial and other interests which are material and relevant

1)that the details listed above are correct and that where I have left a blank I have no interest in that category: or

2)that the details listed above represent changes or additions to the interests previously declared by me: or

3)that there are no changes in the details previously declared: or

4)that I have no such interests

I undertake to revise this statement whenever there are material changes in my circumstances and to review the accuracy of the information at the beginning of each Council session or periodically as required.

I give my consent for this statement to be used if I take a seat on Council for the purposes described in the conflicts of interest policy which include inclusion in the register which is available for public inspection in the RIBA Library and for no other purpose.

I will undertake to notify any relevant interest at any meeting where I am involved in making decisions on any matter which may affect my personal interests and I will not participate in any discussion or decision on such matter.

Signature:……………………………………Date…………………….2017