Census and Statistics Act 1905Census and Statistics Act 1905

Schedule Undertaking of fidelity and secrecy

(regulation 4)

Census and Statistics Act 1905

UNDERTAKING OF FIDELITY AND SECRECY

I,\[Name\] of \[Address\]

being an officer within the meaning of the Census and Statistics Act 1905, hereby undertake that I will faithfully and to the best of my ability execute the powers or duties conferred or imposed on me by or under that Act or the regulations and that I will not, except

(a) in accordance with a determination under that Act; or

(b) for the purposes of that Act,

either directly or indirectly, divulge or communicate any information furnished in pursuance of that Act to any person (other than the person from whom the information was obtained).

Dated 19 .

[Signature of officer]

Signed in the presence of:

[Signature and legible statement of name and address of witness]