Sch 1Register of interest—primary return

Schedule 1—Register of interest—primary return Please read instructions and notes below before completing this return.

SURNAME OTHER NAMES OFFICE HELD

Registrable interests Details Provide a statement of any income source2 that you have or a person related to you3 has or expects to have in the period of 12 months after the date of the primary return.

State the name of any company or other body, corporate or unincorporate, in which you hold, or a member of your family4 holds, any office whether as director or otherwise, for the purpose of obtaining financial gain (including at some time in the future).

State the name or description of any company, partnership, association or other body in which you or a person related to you3 is an investor5.

Provide a concise description of any trust (other than a testamentary trust) of which you or a person related to you3 is a beneficiary or trustee, and the name and address of each trustee.

Provide the address or description of any land in which you have or a person related to you3 has any beneficial interest6 other than by way of security for any debt.

Provide details of any fund in which you or a person related to you3 has an actual or prospective interest to which contributions are made by a person other than you or a person related to you3.

If you are or a person related to you3 is indebted to another person (not being related by blood or marriage) in an amount of or exceeding $7 500—state the name and address of that other person.

If you are or a person related to you3 is owed money by a natural person (not being related by blood or marriage) in an amount of or exceeding $10 000—state the name and address of that person.

Declare any other substantial interest of yours or of a person related to you whether of a pecuniary nature or not, of which you are aware and which you consider might appear to raise a material conflict between your private interest and the duty that you have or may subsequently have as a member of a designated entity.

Provide any other additional information which you think fit.

Signature

Date

Instructions/notes This return is to be completed in block letters except for signatures. If there is not sufficient space on this return for all of the information you are required to provide, you may attach additional papers for that purpose. Each such paper must be signed and dated. (b) any trade, vocation, business or profession engaged in by the person. 3.1 A person related to a member means— (a) a member of the member's family; (b) a family company of the member; (c) a trustee of a family trust of the member. 3.2 A family company of a member means a proprietary company— (a) in which the member or a member of the member's family is a shareholder; and (b) in respect of which the member or a member of the member's family, or any such persons together, are in a position to cast, or control the casting or, more than one‑half of the maximum number of votes that might be cast at a general meeting of the company. 3.3 A family trust of a member means a trust (other than a testamentary trust)— (a) of which the member or a member of the member's family is a beneficiary; and (b) which is established or administered wholly or substantially in the interests of the member or a member of the member's family, or any such persons together. Under the Act— family, in relation to a member, means— (a) a spouse or domestic partner of the member; and (b) a child of the member who is under the age of 18 years and normally resides with the member. For the purpose of this return, a person is an investor in a body if— (a) the person has deposited money with, or lent money to, the body that has not been repaid and the amount not repaid equals or exceeds $10 000; or (b) the person holds, or has a beneficial interest in, shares in, or debentures of, the body or a policy of life insurance issued by the body. A beneficial interest in property includes a right to re‑acquire the property. 1 A member is required only to disclose information that is known to the member or ascertainable by the member by the exercise of reasonable diligence. 2 A member is not required to disclose information relating to a person as trustee of a trust unless the information relates to the person in the person's capacity as trustee of a trust by reason of which the person is related to the member. 3 A member may include in a return such additional information as the member thinks fit. 4 Nothing in this return will be taken to prevent a member from disclosing information in such a way that no distinction is made between information relating to the member personally and information relating to a person related to the member. 5 A member is not required to disclose the actual amount or extent of a financial benefit or interest. Schedule 2—Register of interest—ordinary return Please read instructions and notes below before completing this return.