UNIVERSITY OF CAMBRIDGE

Declaration of Interests

This form is for use by members of committees and boards within Faculties, Departments and other Institutions to declare financial and other interests which fall within each of the categories specified below. The declaration does not replace the need for individuals separately to declare relevant personal interests during the course of the business of any committee, board or other body of which they are a member.

Name:		

1.   Trusteeships of other charities
Please note that this includes any position (whether paid or unpaid) on the governing body or board of directors of any charitable body, including a charitable subsidiary undertaking, whether or not the position is formally described as a trusteeship.
 	
Name of charitable trust or other charitable body*		
Position		
Date of Appointment		
* in the case of a registered charity, please give the full name of the charity as listed in the Charity Commission’s register of charities (see http://www.charity-commission.gov.uk/showcharity/registerofcharities/RegisterHomePage.aspx)’	

2.   Directorships (including non-executive directorships) of publicly quoted or private companies (including wholly owned subsidiaries of the University) 	
Name of Company		
Position		
Date of Appointment		

3.   Positions of employment or other remunerated posts (other than trusteeships or directorships)	
Name of employer or remunerating organisation		
Position		
Date of Appointment		

4.   Consultancies	
Name of Client		
Position		
Date of Appointment		

5.   Significant (>1%) Share Options or Holdings (including those held by partners or close relatives) in private or public companies with which the University has an actual or potential business relationship (e.g. for the provision of services or research of for investment).	
Name of Company		
Shareholding		

6.   Membership of professional bodies, charities or voluntary organisations 	
Name of Organisation		
Position		
Dates of Appointment		

7.   Membership of Lobbying Organisation(s)	
Name of Organisation		
Position		
Dates of Appointment		

8.   Any interests or benefits not declared above which may (or may appear to) influence your decision-making, or might be seen to affect your ability to perform your duties	

	
	
Please append additional sheets if necessary	
		
Date		Signature		

Please return to <……………………………………………………………………....>