Members Interests

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Localism Act 2011 Sections 29 & 30

These are the interests you are obliged to disclose either by law, or under the Parish Council's Standing Orders. You must fill this form in and return it to your Parish Clerk, who will forward it to the Eastleigh Borough Council's Monitoring Officer. You must also let the Parish Clerk know immediately in writing if there is a change to any of the information on this form. A copy of this form is by law required to be published on Fair Oak & Horton Heath Parish Council and Eastleigh Borough Council's websites.

1. Name

First and Last Name *

2. Employment etc

Please state any employment, office, trade, profession or vocation that you carry on for profit or gain.

If you have an employer, please give their name. *

3. Sponsorship

Has any person or body (other than Fair Oak or Horton Heath Parish Council) made any payments to you towards your expenses in carrying out your duties as a councillor, or towards your election expenses, within the last 12 months, such as a political party?

If yes, please give the name of that person or body. You do not need to declare the amount of any payment. *

Name of Person or Body

4. Shares/Securities

Please give the name of any person or body which to your knowledge has a place of business or land in the Fair Oak & Horton Heath Parish Council's area where you have either:

i) A beneficial interest in securities (for example shares, debentures, bonds etc) in the person or body with a nominal value of more than £25,000 or

ii) A beneficial area in securities in the person or body amounting one hundredth of their total issued capital

NB: you need not include monies deposited with a Building Society. *

5. Contracts with Fair Oak & Horton Heath Parish Council

Please describe any contract for goods, services or works between Fair Oak & Horton Heath Parish Council and any of the following:

You, individually
Any firm in which you are a partner
Any company with which you are a director
Any person or body declared under paragraph 4 above.

Contracts *

6. Land in the Fair Oak & Horton Heath Parish Council Area

Please describe with enough detail to identify its location, any land within the Fair Oak & Horton Heath Parish Council area in which you have a beneficial interest (i.e. own, rent lease or have a licence to occupy for a month or longer), wither alone or with others. (please provide a plan if appropriate)

Land *

7. Tenancies

Please describe with enough detail to identify its location, any land where the landlord is Fair Oak & Horton Heath Parish Council and:

You, or
Any firm in which you are a partner, or
Any company with which you are a director, or
Any person or body declared under paragraph 4 above

is the tenant. (Please provide a plan if appropriate)

Tenancies *

8. Non-Pecuniary Interests

Please list any bodies of which you are a member, or are in a position of general control management, and:

i) To which you have been appointed or nominated by Fair Oak and Horton Heath Parish Council as their representative; or *

ii) Which is a public authority or body exercising functions of a public nature; or *

iii) Which is directed to charitable purposes; or *

iv) one of whose principal purposes includes the influence of public opinion or policy (i.e., political party) *

9. Do you have a spouse/partner

Are you married, or do you have a civil partner, or are you living with someone as if you were married or civil partners?

If YES, you must complete Boxes 10 to 15 in respect of your spouse/partner, so far as you are aware of their interests. *

10. Spouse/partner

Please state your spouse/partner's full name.

First and Last name *

11. Spouse/partner's employment etc

Please state any employment, office, trade, profession or vocation that your spouse/partner carries on for profit or gain. .

If your spouse/partner has an employer, please give their name.

12. Spouse/partner's shares/securities

Please give the name of any person or body which to your knowledge has a place of business or land in the Fair Oak & Horton Heath Parish Council's area where your spouse/partner has either:

i) A beneficial interest in securities (for example shares, debentures, bonds etc) in the person or body with a nominal value of more than £25,000 or

ii) A beneficial area in securities in the person or body amounting one hundredth of their total issued capital

NB: you need not include monies that your spouse/partner has deposited with a Building Society. *

13. Spouse/partner's contracts with Fair Oak & Horton Heath Parish Council

Please describe any contract for goods, services or works between Fair Oak & Horton Heath Parish Council and any of the following:

Your spouse/partner as an individual
Any firm in which spouse/partner is a partner
Any company with which your spouse/partner is a director
Any person or body declared under paragraph 12 above.

Spouse/Partner Contracts *

14. Spouse/partner's land in the Fair Oak & Horton Heath Parish Council Area

Please describe with enough detail to identify its location, any land within the Fair Oak & Horton Heath Parish Council area in which your spouse/partner has a beneficial interest (i.e. own, rent lease or have a licence to occupy for a month or longer), wither alone or with others. (please provide a plan if appropriate)

Spouse/partner's land *

15. Spouse/partner's tenancies

Please describe with enough detail to identify its location, any land where the landlord is Fair Oak & Horton Heath Parish Council and:

Your spouse/partner or,
Any firm in which spouse/partner is a (business) partner
Any company with which your spouse/partner is a director
Any person or body declared under paragraph 12 above.

is the tenant. (Please provide a plan if appropriate)

Spouse/partner's tenancies *

Declaration

As a member of Fair Oak & Horton heath parish Council, I declare that the information set out above is a true and complete record of the Interests that I must declare under the Relevant Authorities (Disclosable Pecuniary Interests) Regulations and the Council's Standing orders.

I understand that it is a criminal offence if I provide false or misleading information about my, or my souse/partner's disclosable pecuniary interests when I know the information is misleading or am reckless as to whether it is true and not misleading.

Signed by Member

Clear Signature

Add Name

Received:

Proper Officer, Fair Oak & Horton Heath Parish Council.

Signed by Proper officer