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;
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Organisation name™ (as it appears
in your your governing document)
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in your your governing document) Number of charit trustees
Mandatory Complete additional declarations if you have more than 6 trustees
Trustee i Trustee 2, pa ee Trustee 2 a _ al nee > r2€ iad
Name 24ertiS fetes daneizow Name Se deni FAIL LO Dele Name JN UBEET Moare.5 ys :
Signature Nerwen ye
he Signature Se bru Be Signature UU We AGG~
Date_{5 Tety 2Ory Date 2é Jury 201% Date_24 tl. 24
Trustee 4 Trustee 5 Trustee 6
Name ANGELA & Fes CBA Nome Ciel Slew Name
Signature Le fou te — Signature Zea Signature.
Date__ +/3 fou Date Date
Working with children and/or vulnerable adults Corporate trusteeship
[| Tick this box if your organisation works with [ | Tick this box if your organisation
children and/or vulnerable adults and has a corporate truistee (a corporation
you declare that you have: which has been appointed to act as a
~>Read and understood the guidance on Access NI checks trustee of a charity) and its directors
~> Carried out all trustee eligibility checks the law requires (or appointed director) are making
and on the basis of those checks are satisfied that the this declaration to act as trustees
people acting as trustees are both eligible and suitable of this charity
as required
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Your eligibility and responsibilities as a charity trustee
-
Each person signing above declares that he/she is:
-
e willing to act as a charity trustee and is fully aware of the organisation’s purposes as set out in the governing document.
-
e not disqualified from acting as a charity trustee of any charity for any of the reasons or on any of the grounds listed in section 86(1) of the Charities Act (Northern Ireland) 2008. These disqualifications broadly include but are not limited to anyone who: » has been convicted of an offence involving deception or dishonesty, unless the » conviction is a spent conviction under the Rehabilitation of Offenders (NI) Order 1978 ». is an undischarged bankrupt or has made an arrangement with creditors » has previously been removed as a trustee by the Commission or by the courts is subject to disqualification under company legislation.
-
e not disqualified and/or barred from acting as a trustee of this particular charity under the provisions of the Safeguarding Vulnerable Groups (Northern Ireland) Order 2007(as amended by the Protection of Freedoms Act 2012) which deal with people who are working in a regulated and/or controlled activity.
You also jointly and individually declare that:
-
e the funds of the organisation are, or immediately upon registration as a charity will be, held in an account in the name of the charity
-
e the information contained on the application form and this charity trustee declaration form is true, complete and correct
-
you understand that to knowingly or recklessly make a false statement is a criminal offence under section 25(1) of the Charities Act (Northern ireland) 2008
-
e you have read and understood the Commission's Public benefit requirement: statutory guidance ® you are aware of your responsibilities as charity trustees and have read the Commission’s guidance Running your charity: support for charity trustees on key aspects of running a charity effectively.
-
Private benefit Ifor your organisation pays (or will pay) ahy. charity trustee for being a trustee any charity trustee or person connected to them for providing goods and
-
services, you declare that you are satisfied this will: » be lawful and properly authorised e be in the organisation’s best interests e directly contribute to or help the organisation in achieving its purposes (or be a necessary by-product of carrying out its purposes).
;
Mises Deni tsraabiom
version 3.0 September ZU16
¢ ry "
meme omecemnnad
|
, ,
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| an Charity Trustee Declaration meme
Organisation name (as it appears in your governing document) _Number of charity trustees
DAWANENA CHORCK HENBERS FORO
.
Mandatory =
Complete additional declarations if you have more than 6 trustees %, 2.
Trustee 1 ; Nesremad Tak Pras veynnad Wes
Name Trustee 2 ail Deatonac30 Trustee 3 ee VOBE
Sé@ewiceeWeenies Name?’ e MeNid Name MAPARA Luanne
Signature acne iSpy Signature Ae 4), Signature Hale Cre
Date_A\ 1S Date Dategeriho
Trustee 4 Trustee 5 Trustee 6
Name SALLY ANN JOHNSTON NameNoRetn) DoRNan Name STUART Licy
Signature Sollyfima Pullen signature acan.S Denar - signature tail Loyd
Date_lo (7/19 Date 16 hia % fogged Date ig.
Working fed i22
[ | Tick thiswith box childrenif your organisation and/or vulnerable works with adults [ | Tick this boxCorporateif your organisation trusteeship
children and/or vulnerable adults and has a corporate trustee (a corporation
you declare that you have: which has been appointed to act as a
->Read and understood the guidance on Access NI checks trustee of a charity) and its directors
-> Carried out all trustee eligibility checks the law requires (or appointed director) are making
and on the basis of those checks are satisfied that the this declaration to act as trustees
people acting as trustees are both eligible and suitable of this charity
as required
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Your eligibility and responsibilities as a charity trustee
-
Each person signing above declares that he/she is:
-
e willing to act as a charity trustee and is fully aware of the organisation’s purposes as set out in the governing document.
-
e not disqualified from acting as a charity trustee of any charity for any of the reasons or on any of the grounds listed in section 86(1) of the Charities Act (Northern Ireland) 2008. These disqualifications broadly include but are not limited to anyone who:
-
; >» has been convicted of an offence involving deception or dishonesty, unless the >» conviction is a spent conviction under the Rehabilitation of Offenders (NI) Order 1978 is an undischarged bankrupt or has made an arrangement with creditors
-
has previously been removed as a trustee by the Commission or by the courts >» is subject to disqualification under company legislation.
-
e not disqualified and/or barred from acting as a trustee of this particular charity under the provisions of the Safeguarding Vulnerable Groups (Northern Ireland) Order 2007(as amended by the Protection of Freedoms Act 2012) which deal with peaple who are working in a regulated and/or controlled activity.
You also jointly and individually declare that:
-
e the funds of the organisation are, or immediately upon registration as a charity will be, held in an account in the name of the charity
-
e the information contained on the application form and this charity trustee declaration form is true, complete and correct
-
e you understand that to knowingly or recklessly make a false statement is a criminal! offence under section 25(1) of the Charities Act (Northern Ireland) 2008
-
e you have read and understood the Commission’s Public benefit requirement: statutory guidance e you are aware of your responsibilities as charity trustees and have read the Commission’s guidance Running your charity: support for charity trustees on key aspects of running a charity effectively.
-
.
Private benefit
-
If your organisation pays (or will pay) any charity trustee for being a trustee s services,or any charityyou trusteedeclare orthat person connected you are satisfied tothis themwill: for providing goods and TheCharit e : V be lawful and properly authorised ‘
-
e be in the organisation’s best interests Ssion. e directly contribute to or help the organisation in achieving its for Northern ireland purposes (or be a necessary by-product of carrying out its purposes).
Trustee Declaration
Version 3.0
September 2016
ee &