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FORM A
REGISTER OF INTERESTS
STOCKTON-ON-TEES BOROUGH COUNCIL
DISCLOSABLE PECUNIARY INTERESTS
Notification by a Councillor or Co-opted Member of Stockton-on-Tees Borough Council of his/her
disclosable pecuniary interests and the disclosable pecuniary interests of the Councillor’s or
Member’s spouse or civil partner, a person with whom the Councillor or Member is living as
husband and wife, or a person with whom they are living as if they were civil partners.
Please read the attached notes when completing this form.
Councillor/Member’s Name (in full) …………………………………………………………………..
I hereby give notice of the following disclosable pecuniary interests (please state none where
appropriate).
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Any employment, office, trade, profession or
vocation carried on for profit or gain.
2.
Any payment or provision of any other
financial benefit (other than from the relevant
authority) made or provided within the
relevant period in respect of any expenses
incurred by M in carrying out duties as a
member, or towards the election expenses of
M. (This includes any payment or financial
benefit from a trade union within the
meaning of the Trade Union and Labour
Relations (Consolidation) Act 1992).
3.
Any contract which is made between the
relevant person (or a body in which the
relevant person has a beneficial interest) and
the relevant authority:
(a) Under which goods or services are to be
provided or works are to be executed;
and;
(b) Which has not been fully discharged.
4.
Any beneficial interest in land which is within
the area of the relevant authority.
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5.
Any licence (alone or jointly with others) to
occupy land in the area of the relevant
authority for a month or longer.
6.
Any tenancy where (to M’s knowledge):
(a) The landlord is the relevant authority;
and
(b) The tenant is a body in which the
relevant person has a beneficial
interest.
7.
Any beneficial interest in securities of a body
where:
(a) That body (to M’s knowledge) has a
place of business or land in the area of
the relevant authority; 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 shares 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: …………………………………………………....
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Spouse or Civil Partner’s etc Name (in full) …………………………………………………………..
Signed: ……………………………………………………..
Councillor/Co-opted Member
Dated: ……………………………………………………..
Signed: ……………………………………………………..
Monitoring Officer/Deputy Monitoring Officer/Other Officer
Dated: ……………………………………………………..