Trustee’s Declaration Form
Charity Name(s)Title
Full Name
Post Nominals
Former Names
Home Address
Previous home address(es) in the last 7 years
Correspondence address (If different from above)
Address to appear on Companies House Register / Recommended the Company’s Registered Office, please indicate below if different:
Home Address
Correspondence Address
Email Address
Contact telephone number(s)
Date of Birth
Place of Birth
Nationality
Occupation
I the undersigned, agree that:
· I am willing to act as a trustee of the organisation(s) named above,
· I understand the organisations’ purposes (objects) and the rules set out in the governing documents or I will seek to understand these before formal appointment,
· At the time of completing this declaration I am aged 16 years or above
· I am not prevented from acting as a trustee and agree that:
o I do not have an unspent conviction for an offence involving dishonesty, deception, terrorism, money laundering, bribery, contravening a Charity Commission order or direction, misconduct in public office, perjury, perverting the course of justice, or aiding, attempting or abetting any of these offences,
o I am not on the sex offenders register,
o I do not have an unspent sanction for contempt of court,
o I have not been found guilty of disobeying a Charity Commission order,
o I am not a designated person under anti-terrorist legislation,
o I am not currently declared bankrupt (or subject to bankruptcy restrictions or an interim order),
o I do not have an individual voluntary arrangement (IVA) to pay off debts with creditors,
o I am not disqualified from being a company director,
o I am not subject to an order made under section 429(2) of the Insolvency Act 1986,
o I have not previously been removed as a trustee by the Charity Commission, the Scottish Charity regulator or the High Court due to misconduct or mismanagement,
o I have not been removed from management or control of any body under section 34(5)(e) of the Charities and Trustee Investment (Scotland) Act 2005 (or earlier legislation),
o I am not disqualified from being a trustee by an order of the Charity Commission under section 181A of the Charities Act 2011,
o I would not be unable to meet HMRC’s “Fit and Proper Person” test.
· The information provided, that will be registered with the Charity Commission and Companies House when appropriate, is true, complete and correct and I will seek to promptly notify the National Museum of the Royal Navy and the appropriate bodies if any of this information changes,
· I understand that it is an offence under section 60(1)(B) of the Charities Act 2011 to knowingly or recklessly provide false or misleading information,
· I will comply, if appointed, with my responsibilities as laid out by the Charity Commission and will seek to read and understand the Charity Commission guidance: “The Essential Trustee (CC3)”.
Furthermore I consent to the National Museum of the Royal Navy (NMRN) carrying out the following online searches about myself:
· Charity Commission Register of Removed Trustees
· Companies House Database of Disqualified Directors
· Insolvency Services Register of Disqualified Directors and Insolvency Services Individual Insolvency Register
· A general google search to include news articles, self-published articles, business websites and social media to establish an understanding of my reputation.
· Retaining the information gained from above for a period of no longer than seven years after my resignation from the Charity if successful and for no more than a year if unsuccessful.
Signed:
Date:
Any information obtained in this form will be retained under the NMRN’s data retention and privacy policies. It will not be shared with any third parties or used for marketing/fundraising information. The NMRN and its subsidiary companies undertake to use this information for the sole purpose of trustee recruitment and for any subsequent appointment as a trustee and correspondence with you in relation to that position.
INTERNAL USE ONLY
Search Carried Out / Date / Relevant Information Found (Y/N) / Evidence of any Relevant Information Attached / Name of Searcher / SignedCharity Commission
Companies House
Insolvency Services Disqualified Directors
Insolvency Services Individual Insolvency Register
Reputational Search