Terms of reference

Appendix two: Register of Interests Registration Form

I, [name] as member of the Leyland Town Board have set out below my interests in accordance with the Town Deal Board's term of reference and code of conduct. Please give details of interest, specifying dates and endings of appointments for the following:

1. Current employment and any employment held in the last 12 months: 

2. Details of all businesses in which I am a partner or sole proprietor: 

3. Current appointments (voluntary or otherwise) e.g. trusteeships, directorships, tribunals etc.: 

4. Current membership of any professional bodies, special interest groups or mutual support organisations: 

5. Gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months: 

6. Details of existing business interests, company directorships and trusteeships of immediate family (to include spouse/ partner, siblings, children and parents): 

To the best of my knowledge, the above information is complete and correct. I undertake to update the information provided within 28 calendar days of any information changing or a new interest becoming registrable and to review the accuracy of the information on an annual basis.

I undertake to declare any interest which I have in any matter, to be considered at a meeting. I give my consent for it to be used for the purposes described in the Terms of Reference and Code of Conduct and for no other purpose. I give my consent for this notification to be published on the Leyland Town Deal website.

I understand that by signing this notification I am also agreeing to abide by the LTB Code of Conduct.



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