Please Read the Notes at the End of This Form

Localism Act 2011 – Section 29 and 30 and The Relevant Authorities (Disclosable Pecuniary Interests) Regulations 2012

I(full name)

A member of: Council

GIVE NOTICE that I and to the best of my knowledge my spouse/civil partner, person with whom I live as husband and wife, or person with whom I live with as a civil partner (i.e. being relevant persons in accordance with the regulations) have the following pecuniary interests which are specified for the purposes of section 30(3) of the Localism Act 2011 (please state ‘none’ where appropriate)

PLEASE READ THE NOTES AT THE END OF THIS FORM

(1)Employment, office, trade, profession or vocation Any employment, office, trade, profession or vocation carried on for profit or gain.

(2)Sponsorship Any payment or provision of any other financial benefit (other than from the Council) made or provided within the relevant period in respect of any expenses incurred by you in carrying out duties as a member, or towards your election expenses.

(3)Contracts Any contract which is made between the relevant person (or a body in which the relevant person has a beneficial interest) and the Council –

(i)under which goods or services are to be provided or works are to be executed; and

(ii)which has not been fully discharged.

(4)Land Any beneficial interest in land which is within the area of the Council.

(5)Licences Any licence (alone or jointly with others) to occupy land in the area of the Council for a month or longer.

(6)Corporate Tenancies Any tenancy where, to your knowledge –

(i)the landlord is the Council; and

(ii)the tenant is a body in which the relevant person has a beneficial interest.

(7)Securities Any beneficial interest in securities of a body where –

(a)that body, to your knowledge, has a place of business of land in the area of the Council; and

(b)either –

(i)the total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body; or

(ii)if the share capital of that body is of more than one class, the total nominal value of the share of any one class in which the relevant person has a beneficial interest exceeds one hundredth of the total issued share capital of that class.

Date

Signed

Note

Please check your entries in the register regularly to ensure that they are up to date.

Any revisions must be notified in writing (including email) by you to the Monitoring Officer who will confirm receipt of your notification and that the entry will be made to your pages on the register. Forms for updates can be obtained from Democratic Services by e-mailing .

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Explanatory Notes

For the purposes of this form –

“relevant person” means that a pecuniary interest is a ‘disclosable pecuniary interest’ in relation to you if it is your interest, or it is an interest of yourself or:

(i)your spouse or civil partner,

(ii)a person with whom you are living as husband and wife, or

(iii)a person with whom you are living as civil partners, and you are aware that the other person has the interest.

“relevant period” means 12 months ending with the day on which the member gives the notification.

“the Act” means the Localism Act 2011;

“body in which the relevant person has a beneficial interest” means a firm in which the relevant person is a partner or a body corporate of which the relevant person is a director, or in the securities of which the relevant person has a beneficial interest;

“director” includes a member of the committee or management of an industrial and provident society;

“land” includes an easement, servitude, interest or right in or over land which does not carry with it a right for the relevant person (alone or jointly with another) to occupy the land or to receive income; and

“securities” means shares, debentures, debenture stock, loan stock, bonds, units of a collective investment scheme within the meaning of the Financial Services and Markets Act 2000(b) and other securities of any description, other than money with a building society.