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«Name: Designated Position of Employment Held: Public Body: Date of Appointment: Period comprehended by this Statement (i.e. 1 January to 31 December ...»

Ethics in Public Office Acts 1995 and 2001

- Designated Positions of Employment Statement of Interests for the purposes of Section 18 of the

Ethics in Public Office Act 1995

Please complete in BLOCK CAPITALS

Name:

Designated Position of

Employment Held:

Public Body:

Date of Appointment:

Period comprehended

by this Statement (i.e.

1 January to 31 December or

part thereof):

Address for Correspondence:

In relation to each of the following registrable interests, you should state any interest held by you and any interests held, to your actual knowledge, by your spouse, a child of yours, or a child of your spouse, which could materially influence1 you in or in relation to the performance of your official functions. The amount or monetary value of the interests need not be specified. Explanatory notes on certain of the required statements are attached.

1. OCCUPATIONAL INCOME, ETC.

Details of any remunerated trade, profession, employment, vocation or other occupation (other than the position of employment described on the first page of this form), the remuneration from which exceeded €2,600, during the period comprehended by this statement, should be listed here.

Description of Occupation Business Address

Self:

Spouse or Child (name):

2. SHARES ETC.

Details of any holding of shares in, or bonds or debentures of, or other like investments in, a particular company or other enterprise or undertaking, where the aggregate value of the holding exceeded €13,000 at any time during the period comprehended by this statement, should be listed here2.

Type of Holding Where held Nature of Business

Self:

Spouse or Child (name):

3. DIRECTORSHIPS Details of any directorship or shadow directorship of any company held during the period comprehended by this statement should be listed here3.

Type of Directorship Business Address Nature of Business

Self:

Spouse or Child (name):

LAND (EXCLUDING PRIVATE HOME4)

4.

Details of any interest in land where the value of such interest exceeded €13,000 at any time during the period comprehended by this statement should be listed here, including i) any contract entered into for the purchase of land, whether or not a deposit or part payment has been made under the contract; and (ii) any option held to purchase land, whether or not any consideration has been paid in respect thereof, or land in respect of which such an option has been exercised but has not yet been conveyed.

Property Address Purpose for which used

Self:

Spouse or Child (name):

5. TRAVEL, ACCOMMODATION, MEALS, ETC.

Details of travel facilities, living accommodation, meals or entertainment supplied during the period comprehended by this statement, free of charge or at a price that was less than the commercial price or prices, should be listed here5.

–  –  –

Self:

Spouse or Child (name):

6. OTHER REMUNERATED POSITIONS

Details of any remunerated positions held as a political or public affairs lobbyist, consultant or adviser during the period comprehended by this statement, should be listed here.

–  –  –

Self:

Spouse or Child (name):

7. PUBLIC SERVICE CONTRACTS

Details of any contract to which the person concerned was a party, or was in any other way, directly or indirectly interested, for the supply of goods or services to a Minister of the Government, or a public body during the period comprehended by this statement, if the value of the goods or services supplied exceeded €6,500 or, in case other goods or services were supplied under such a contract if the aggregate of their value and the value aforesaid exceeded €6,500, should be listed here.

–  –  –

In line with the provisions of Section 30 of the Ethics in Public Office Act 1995, voluntary statements in respect of any interests not specified in the Second Schedule to that Act (i.e., other than those specified at 1. to 8. above), and which are held by you or your spouse, or a child of yours or your spouse, may be listed here if it is considered that such interests could materially influence you in or in relation to the performance of your official duties.

Self:

Spouse or Child (name):

Signed: _______________________ Date: _______________________

NOTES which could materially influence you in or in relation to the performance of the functions of the position of employment by reason of the fact that such performance could so affect those interests as to confer on or withhold from you or your spouse or child of yours or child of your spouse a substantial benefit.

"holding" does not include money in a current, deposit or other similar account with a financial institution.

"shadow directorship" means the position held by a person who is a shadow director within the meaning of the Companies Acts 1963 to 1990, or, in the case of a public body that is not a company (within the meaning of the Companies Act 1963) and is specified in subparagraph (8), (9), (10), (11), or (12), or stands prescribed for the purposes of subparagraph (13), of paragraph 1 of the First Schedule to the Ethics in Public Office Act 1995, the position held by the person in accordance with whose instructions or directions, the members of the body, or the members of the board or other body that controls manages or administers that body, are accustomed to act.

i.e. excluding any interest in land consisting of any private home of the person or of his or her spouse, that is to say, a building or part of a building that is occupied by the person, or his or her spouse, or a child of the person, or of the spouse, as a separate dwelling and any garden or other land usually occupied with the dwelling, being land that is subsidiary or ancillary to it, is required for its amenity or convenience and is not being used or developed primarily for commercial purposes.

but excluding:

(a) travel facilities, living accommodation, meals or entertainment provided

–  –  –

(b) travel facilities, living accommodation, meals or entertainment supplied to the person by a relative or friend of the person, or of his or her spouse, or of a child of the person or of his or her spouse, where such supply was in the nature of a gift to the person and for personal reasons only, unless the acceptance of such facilities, accommodation, meals or entertainment might reasonably be seen to have been capable of influencing him or her in the performance of his or her functions as an occupier of a designated position of employment;

(c) travel facilities, living accommodation, meals or entertainment supplied to the person, once or more than once by the same person during the period comprehended by this statement, free of charge if the commercial price, or the aggregate of the commercial prices, of the facilities, accommodation, meals or entertainment did not exceed €650; or (d) travel facilities, living accommodation, meals or entertainment supplied to the person, once or more than once by the same person during the period comprehended by this statement, at a price or prices less than the commercial price or prices by not more than €650.

but excluding:

(i) a gift to the person by a relative or friend of the person or of his or her spouse, or of a child of the person or of his or her spouse, for purely personal reasons only, unless the acceptance of the gift by the person could have materially influenced him or her in the performance of his or her functions as an occupier of a designated position of employment;

and (ii) a gift given to the person, or gifts given to the person by the same person, during the period comprehended by the statement, as respects which the value, or the aggregate value, of the property the subject of the gift or gifts did not exceed €650 at any time during the period comprehended by the statement.

other than property supplied or lent, or a service supplied to a person by a relative or friend of the person, or of his or her spouse, or of a child of the person or of his or her spouse, where such supply or loan was in the nature of a gift to the person and for personal reasons only, unless the acceptance of the property or loan or the service by the person could have materially influenced him or her in the performance of his or her functions as an occupier of a designated position of employment.

insofar as services in (ii) and (iii) relate to legal or medical services (including psychiatric or psychological services), it is only necessary to state that such services were supplied to you or to a person (who need not be identified) in respect of whom you are required to make a statement.

ETHICS IN PUBLIC OFFICE ACT 1995 SECTION 18

–  –  –





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