Community Asset Committees Nomination Form

I have read the Instrument of Delegation for the Community Asset Committees I am seeking membership of, and I agree to abide by the roles and responsibilities outlined therein if I am appointed to the Committee.
I further declare that I:
• Have not been convicted of any indictable offence;
• Have not been convicted of fraud;
• Have not been disqualified from acting as a director or acting in the management of a company; and
• am not facing court proceedings for any criminal proceedings, including bankruptcy.