WEST PARK SCHOOL

Legal Name

Full Name including any middle names

Any other Names known as

Full Name(s) including any middle names

Date of Appointment

Start Date at West Park School

West Park employees and governors are required to disclose details of material transactions with related parties. Related parties include its members of their close families and partnerships, companies, trusts or other entities in which the individual, or a member of their close family, has an interest.

Notes for completion of form

Note 1 Family Members - members of close family (husband, wife, partner, children, children of spouse/partner, dependants or dependants of spouse/partner).

Note 2 This could include a partnership, company, trust or other entities in which the individual or a member of their close family or household has an interest.

Note 3 For the purpose of clarity, the term “interest” relates here to where an individual is a director or an employee involved in business or organisation

Note 4 Transactions with the West Park may include:

- the purchase, sale, lease, rent or hire of assets or property between West Park and the related party

- the provision of a guarantee by West Park in relation to a liability or obligation of the related party

- the provision of services, sponsorship or financial support by West Park to a related party

- the provision of services to West Park by a related party

- any other arrangement, including those where no financial transaction takes place - e.g. services provided free of charge

Are you or a close family member (spouse, partner, children, children of spouse/domestic partner, dependents or dependents of spouse/partner) a director or in a position of influence within any company or organisation?

Yes

No

If the answer to either of the above question was “YES”, please complete the questions below as fully as possible for each and every interest. If No please Sign and Date the end of this form

Interest 1 - Name of Organisation

Interest 1 - Name of family member (if you, state “your name”) See Note 1

Interest 1 - Date from which involved

Interest 1 - Date interest ceased

Interest 1 - Relationship to yourself Note 1

Interest 1 - Name and address of organisation

Interest 1 - Relationship with organisation - e.g. Director / Manager / Purchasing Officer Note 3

Interest 1 - Details of any transaction / agreement with West Park School (if none please enter N/A) Note 4

Interest 2 - Name of Organisation

Interest 2 - Name of family member (if you, state “your name”) See Note 1

Interest 2 - Date from which involved

Interest 2 - Date interest ceased

Interest 2 - Relationship to yourself Note 1

Interest 2 - Name and address of organisation

Interest 2 - Relationship with organisation - e.g. Director / Manager / Purchasing Officer Note 3

Interest 2 - Details of any transaction / agreement with West Park School (if none please enter N/A) Note 4

Interest 3 - Name of Organisation

Interest 3 - Name of family member (if you, state “your name”) See Note 1

Interest 3 - Date from which involved

Interest 3 - Date interest ceased

Interest 3 - Relationship to yourself Note 1

Interest 3 - Name and address of organisation

Interest 3 - Relationship with organisation - e.g. Director / Manager / Purchasing Officer Note 3

Interest 3 - Details of any transaction / agreement with West Park School (if none please enter N/A) Note 4

By completing this form I confirm

I have read and understood the Conflict of Interest Policy YES YES

I have declared all pecuniary and personal interests YES YES

Date and Time

Signature

Clear

WEST PARK SCHOOLForm - register of pecuniary and personal interests for School Staff and Governors