Department of Energy and Climate Change

DEPARTMENT OF ENERGY AND CLIMATE CHANGE

Conflict of Interests Declaration

Full Name:

Position:

Date:

(Please tick the statement which applies.) Either:

I declare that to the best of my knowledge and belief neither I nor my spouse/partner/immediate family have any business or financial interests, share holdings, positions of authority, retainers, consultancy arrangements or other connections with commercial, public or voluntary bodies which might conflict, or be perceived to conflict, with my official duties at the Department of Energy and Climate Change.

I declare private interests detailed below for consideration and have also set out the action I am taking to minimise the risk of these interests coming into conflict or perceived conflict with my official duties at the Department of Energy and Climate Change. I certify that the information included within this register is, to the best of my knowledge and belief, true and accurate and complete.

Signed......

Dated......

*Copies of this document will be held by the Board Secretariat.

1.Directorships

Please list all Directorships (held within the last two years), with a brief description of the company and any possible links to the Department of Energy and Climate Change or any other Government Departments (directly or indirectly). Please include any partnerships. Please include any action you are taking, where appropriate, to minimise risks of conflict of interests.

2.Shareholdings

Please list any significant shareholdings in companies, which may have a relationship with the Department of Energy and Climate Change, through Directorships, Trading arrangements or links directly or indirectly to any other Government departments. As a guide “significant” would be any shareholding in a private company and 1% in a public company or any significant shareholding that could be construed as potentially a conflict of interest where the company is engaging in large business transactions with the Department.

3.Close relations and friends

Please list any possible conflicts of interests created by virtue of the employment, directorships or significant shareholding of a close relation or friend.

4.Any other matters

Please list any other matter, which may give rise to a potential conflict of interest, e.g. consultancy contracts, external examinerships with academic institutions, membership of committees/organising bodies with decision making or purchasing powers, membership of political or lobby organisations, including Trusteeship of charitable or other bodies, beneficial ownership of property etc.

5. Management of conflicts of interests

5.Management of conflicts of interest

Please detail how any identified actual or perceived conflict of interests will be managed.