SCHEDULE (Section 14) FORM 1A STATEMENT OF

SCHEDULE
(Section 14)
FORM 1A
STATEMENT OF REGISTRABLE INTERESTS
(Section 36B)
NAME OF MEMBER: Surname: ………………………………………… First Names:………………………………………………….
MEMBER’S ADDRESS:…………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
DATE ELECTED OR APPOINTED TO HOUSE OF ASSEMBLY …………………………………………………..……………………..…
MARITAL STATUS.……………………………………………………………………………………………………………………….…………
NAME OF MEMBER’S SPOUSE*...……………………………………………………………………………………………………...............
NAMES OF MEMBER’S CHILDREN**..………………………………………………………………………………………………….......……
________________________________________________________________________________________________________
*A ‘spouse’, in relation to a person in public life, means a person—
(a) To whom the person in public life is married; or
(b) Who is living with a person in public life in the circumstances of husband and wife for a continuous period of one year during the period that the person’s declaration is required to be filed.
(Section 2 of the Integrity Commission Ordinance)
NB: For the purposes of this declaration you are considered married whether or not separated, living separate and apart, or in divorce proceedings.
**A ‘child’, in relation to a person, means the person’s child who has not attained the age of eighteen years and is not married and includes a step-child or an adopted child; and, in respect of a
man, includes a child born out of wedlock of whom the man had been adjudged the father by a court of competent jurisdiction or whom the man had acknowledged to be his own child.
STATEMENT OF REGISTRABLE INTERESTS FOR THE YEAR ENDED 31ST DECEMBER 20…….
Complete this form and file it together with the Declaration of Income, Assets and Liabilities which you are required to file with the
Integrity Commission under section 25 of the Integrity Commission Ordinance.
(Where insufficient space has been provided for the items falling under section, additional information may be supplied on separate sheets).
Note:
There is no requirement to disclose in this statement, the actual amount or extent of any financial benefit, contribution or interests.
Please notify the Commission of any change which may occur in this Statement with six weeks of such change occurring.
Warning:
Under section 36 F of the Integrity Commission Ordinance, it is an offence (punishable by a fine of $15,000 or 1 years imprisonment or both) to knowingly file with the Commission a
declaration that is not complete, or which is false in any material particular.
1.
I / MY SPOUSE / MY CHILD HOLD(S) DIRECTORSHIPS IN THE FOLLOWING COMPANIES OR OTHER CORPORATE BODIES:
Name of Company of other Corporate Body
Address
2.
I / MY SPOUSE / MY CHILD AM (IS) A PARTY TO, OR A PARTNER IN A FIRM OR A DIRECTOR OR MANAGER OF A COMPANY THAT IS A
PARTY TO A CONTRACT WITH THE GOVERNMENT, OR HAVE (HAS) AN INTEREST IN SUCH A CONTRACT,AS FOLLOWS:
Date and Nature of Contract
Particulars of Interest in Contract or Obligations Undertaken
3.
I / MY SPOUSE / MY CHILD HAVE (HAS) INVESTMENTS IN THE FOLLOWING COMPANIES, PARTNERSHIPS OR ASSOCIATIONS:
Name and Address of Company/Partnership/Association
Brief Particulars of Entity
4.
I / MY SPOUSE / MY CHILD HOLD(S) THE POSITION OF BENEFICIARY OR TRUSTEE IN THE FOLLOWING TRUSTS:
Name of Trust and Position Held
Brief Particulars of Trust
5.
I / MY SPOUSE / MY CHILD HAVE (HAS) BENEFICIAL INTERESTS IN THE FOLLOWING LANDS:
Location, Description and Area of Lands
Beneficial Interest
6.
I / MY SPOUSE / MY CHILD HAVE (HAS) MADE CONTRIBUTIONS TO THE FOLLOWING FUNDS:
Name and Address of Fund
7.
I / MY SPOUSE / MY CHILD HOLD(S) MEMBERSHIPS IN THE FOLLOWING POLITICAL, TRADE OR PROFESSIONAL ASSOCIATIONS:
Name and Address of Association
8.
Controller of Fund
Type of Association
(Political/Trade/Professional)
I / MY SPOUSE / MY CHILD HAVE (HAS) RECEIVED INCOME FROM THE FOLLOWING SOURCES:
Description of Income
Source
9.
I / MY SPOUSE / MY CHILD HAVE (HAS) THE FOLLOWING OTHER SUBSTANTIAL INTERESTS WHICH MAY APPEAR TO RAISE A
MATERIALCONFLICT BETWEEN MY PRIVATE INTEREST AND MY PUBLIC DUTY:
Nature of Interest (Pecuniary or Non-Pecuniary)
DECLARATION
I,…....................................................................................................(full name of member), hereby declare that the contents of my statement
of registrable interests are true to the best of my knowledge and I make it knowing that I am liable to criminal prosecution if I have made a
statement which I know to be false, or do not believe to be true.
Dated this ………….day of ………………………20……
In the presence of: ...........................………...(Name of witness)
……….....................................................(Address of witness)
Dated this……….day of ……………………............20……
Signature of Witness:..........................................................................
Signature of member: …………………………………...