Form 2—Register of interests of a

Department of Local Government, Rac ing and Multicultural Affairs

  Adding a particular
  Place a cross in the ‘add’ box in the left hand column when adding a new particular to your register of
  interests.
  Removing a particular
  Place a cross in the ‘remove’ box in the left hand column when removing a particular from your
  register of interests.
  If there is insufficient space on this form for all of the details you are required to give you may attach
  additional papers for that purpose. You must sign and date each additional paper.
  When completing this form, insert the words ‘not applicable’, where appropriate.
  The completed form (with an envelope marked ‘confidential’) is to be sent, within 30 days of
  commencement of duty or any changes of circumstances to the chief executive officer of your local
  government.
  Related persons
  A person related to a councillor need not include information regarding an interest held jointly or in
  common with the councillor which is already included in the councillor’s register of interests.
  Section notes
  The header of each field includes a reference in italics to the relevant section in Schedule 5 of the
  Local Government Regulation 2012.
  The following notes may assist you with completing your register of interests.
(a   Noes                                                 eons
       If a councillor, complete section A.                 A related person is a spouse, a dependent child
                                                            or someone whose affairs are so closely
       If a related person to a councillor, complete section | connected with the affairs of a councillor, chief
       A and B.                                             executive officer or senior executive employee,
                                                            that a benefit derived by that person, or a
                                                            substantial part of it, could pass to the
                                                            councillor, chief executive officer or senior
                                                            executive employee.
       2:1                                                  A Corporation includes—
       1.  If relevant person is a shareholder or has a     e   acompany,
           controlling interest in a corporation state the  e   any body corporate (whether incorporated
           name of the corporation.                             in this jurisdiction or elsewhere), and
       2.  Ifthe relevant person holds a controlling        e   anunincorporated body    that under the law

   Form 2 — Register of interests of a councillor and their related persons /
   Version no: October 2018                                                                Page 9 of 14