Disclosure of Interests Return

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
Full Name
If FIRST return:
- ‘return date’ is the date you became a councillor or designated person
- leave the return ‘period’ blank

If disclosing NEW INTEREST:
- ‘return date’ is the date you became aware of the interest(s)
- return ‘period’ is from 30 June of the previous financial year, or the date on which you became a councillor or designated person (whichever is later) to the date you became aware of the interest(s).

If ANNUAL return:
- return date’ is 30 June of the current year
- return ‘period’ is from 30 June of the previous year to 30 June of the current year.
Return Date (dd/mm/yyyy)
dd/mm/yyyy - not required if first Return
dd/mm/yyyy - not required if first Return
A. REAL PROPERTY
Street address of each parcel of real property in which I had an interest at the return date/at any time since 30 June, and the nature of interest:
Street address, suburb, postcode - Nature of Interest (e.g. own, part own, rent). List primary residence first to assist with redaction. Separate each new entry with a /
B. SOURCES OF INCOME
1. Sources of income I:
- Reasonably expect to receive from an occupation in the period commencing on the first day after the return date and ending on the following 30 June, and
- Received from an occupation at any time since 30 June:
Description of occupation - Name and address of employer or description of office held (if applicable) - Name under which partnership conducted (if applicable)
2. Sources of income I:
- Reasonably expect to receive from a trust in the period commencing on the first day after the return date and ending on the following 30 June, and
- Received from a trust at any time since 30 June:

Name and address of settlor - Name and address of trustee
Insert 'Nil' if nothing to disclose
3. Sources of income I:
- Reasonbly expect to receive from other income in the period commencing on the first day after the return date and ending on the following 30 June, and
- Received from other income at any time since 30 June:

Include description sufficient to identify the person from whom, or the circumstances in which, that income was received.
Insert 'Nil' if nothing to disclose
C. GIFTS
Description of each gift I received at any time since 30 June, and name and address of donor:
Description - Name and address of donor
Insert 'Nil' if nothing to disclose
D. CONTRIBUTIONS TO TRAVEL
Name and address of each person who made any financial or other contribution to any travel undertaken by me at any time since 30 June, dates on which travel was undertaken, and names of States, Territories of the Commonwealth and overseas countries in which travel was undertaken:
Name and address of person who made contribution - Travel dates - Location
Insert 'Nil' if nothing to disclose
E. INTERESTS AND POSITIONS IN CORPORATION
Name and address of each corporation in which I had an interest or held a position at the return date/at any time since 30 June, nature of interest (if any), description of position (if any), and description of principal objects (if any) of corporation (except in case of listed company):
Name and address - Nature - Description of position - Description of principal objects
Insert 'Nil' if nothing to disclose. Separate each new entry with a /
F. PROPERTY DEVELOPMENT
G. POSITIONS IN TRADE UNIONS AND PROFESSIONAL OR BUSINESS ASSOCIATIONS
Name of each trade union and each professional or business association in which I held any position (whether remunerated or not) at the return date/at any time since 30 June, and description of position:
Name - Description of position
Insert 'Nil' if nothing to disclose. Separate each new entry with a /
H. DEBTS
You do not need to disclose a liability to pay a debt if:
a) The debt arose from a loan you have with a deposit taking institution (e.g. a bank) or other authorised deposit taking institution which lends money, and the loan was part of the institution’s ordinary course of business,
b) The amount to be paid did not exceed $500, unless the debt was one of two or more debts owed to the same person, and the combined value of the debts exceed $500,
c) The debt was owed to a relative,
d) In the case of a debt for the supply of goods or services: the goods or services were supplied to you within the 12 months before the return date, or at any time since 30 June of the previous financial year, or the goods or services were supplied to you in the ordinary course your occupation that is not related to your duties as a councillor or designated person; or
e) The debt was discharged prior to you becoming a councillor or designated person, unless the debt was one of two or more debts you owe to the same person, and the value of the combine debts exceeds $500.
Insert 'Nil' if not applicable
I. DISPOSITIONS OF PROPERTY
Insert 'Nil' if nothing to disclose
Insert 'Nil' if nothing to disclose
J. DISCRETIONARY DISCLOSURES
Insert 'Nil' if nothing to disclose
ACKNOWLEDGEMENT
In submitting this Return:
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’