Full name and Role Date of completion 
Do you have any interests to declare? Please select... YES NO A) All directorships registered under the Companies Act, whether or not they are remunerated.
B) Remunerated employment, office or profession or other activity.
C) other interests, for example: business relationships and/or clients known to have business relationships with the ÃûæÂÖ±²¥ or its associated Companies or which might affect their business; any significant shareholdings in organisations which have business with the ÃûæÂÖ±²¥ or its associated companies; unremunerated posts, honorary positions and other connections which may give rise to a conflict of interest or of trust.
D) Interests where known and material held by spouse, partner, parents, children and siblings as categorised in (a), (b) and (c) above.