Disclosure of Interests Return

A Disclosure of Interest Return (Return) is required to be submitted by Designated Persons in accordance with City of Newcastle (CN) Codes of Conduct that are available on our website.

Important Information

This information is being collected for the purpose of complying with clause 4.21 of the Model Code of Conduct.
You must not lodge a return that you know or ought reasonably to know is false or misleading in a material particular (see clause 4.23 of the Model Code of Conduct). Complaints about breaches of these requirements are to be referred to the Office of Local Government and may result in disciplinary action by the council, the Chief Executive of the Office of Local Government or the NSW Civil and Administrative Tribunal.
The information collected on this form will be kept by the general manager in a register of returns. The general manager is required to table all returns at a council meeting.
Information contained in returns made and lodged under clause 4.21 is to be made publicly available in accordance with the requirements of the Government Information (Public Access) Act 2009, the Government Information (Public Access) Regulation 2009 and any guidelines issued by the Information Commissioner.
You have an obligation to keep the information contained in this return up to date. If you become aware of a new interest that must be disclosed in this return, or an interest that you have previously failed to disclose, you must submit an updated return within three months of becoming aware of the previously undisclosed interest.
For helpful tips on completing your Return, refer to the Office of Local Government Guide to completing Returns of interest.

YOUR DETAILS

Disclosure of pecuniary interests and other matters by

As at

in respect of the period from

A. REAL PROPERTY

B. SOURCES OF INCOME

Include description sufficient to identify the person from whom, or the circumstances in which, that income was received.

C. GIFTS

D. CONTRIBUTIONS TO TRAVEL

E. INTERESTS AND POSITIONS IN CORPORATIONS

F. PROPERTY DEVELOPMENT

Were you a property developer or a close associate of a property developer on the return date:

Yes No

G. POSITIONS IN TRADE UNIONS AND PROFESSIONAL OR BUSINESS ASSOCIATIONS

H. DEBTS

I. DISPOSITIONS OF PROPERTY

J. DISCRETIONARY DISCLOSURES

ACKNOWLEDGEMENT

a) I acknowledge that the information contained in this Disclosure of Interest Return (Return) is true and correct

Yes No

b) I note that lodging a Return that I know or ought reasonably to know is false or misleading in a material particular could amount to a breach of the Code of Conduct and may result in disciplinary action by CN, the OLG or the NSW NCAT

Yes No

c) I consent to the use of an electronic signature to make this declaration. I understand that by typing my name in the below field I will be supplying my electronic signature

Yes No

Signature (type your full name)

Date

Attachment (if applic)

Please select a file

If you would like further information redacted from your Return (other than your residential address), please upload your ‘Request for Omission of information’ and ‘Statutory Declaration’ in PDF format