I have not had any insurance refused, cancelled, declared void (as though it never existed), renewal declined or special terms or conditions imposed by an insurer.

I have not been subject to any bankruptcy proceedings (whether discharged or not) e.g. Individual Voluntary Arrangements (IVAs)/Trust Deeds or been subject to any other statutory insolvency proceedings e.g. Company Voluntary Arrangements (CVAs).

I have not had any court judgements (e.g. CCJs) in the past five years.

I have not been a director of a company which went into liquidation, was put into administration/receivership or subject to arrangements with creditors under statute or, in the last five years, been subject to any court judgements (CCJs).

I have never been the subject of a disqualification order made by a court under the Company Directors Disqualification Act.

I have not been convicted of any non-motoring criminal offence* and I do not have any prosecutions pending. (*You are not required to disclose convictions regarded as ‘spent’ under the Rehabilitation of Offenders Act 1974.)

I have not been prosecuted for breach of any statutory requirements relating to health and safety.

I have not made any claims, suffered uninsured losses or had any claims made against me in the past five years.

I understand the consequences of providing incorrect information.

I understand that I must inform the Trust if I receive a criminal conviction or if I am subject to any ongoing criminal proceedings, County Court Judgements, or any form of bankruptcy or statutory insolvency proceedings.

I have an unspent conviction for one or more of the offences listed in ‘Disqualifications Reasons Table v3’

I have an IVA, debt relief order and/or a bankruptcy order

I have been removed as a trustee in England, Scotland, or Wales (by the Charity Commission or Office of the Scottish Charity Regulator)

I have been removed from being in the management or control of any body in Scotland (under relevant legislation)

I have been disqualified by the Charity Commission

I am a disqualified company director

I am a designated person for the purposes of antiterrorism legislation 

I am on the sex offender’s register 

I have been found in contempt of court for making (or causing to be made) a false statement

I have been found guilty of disobedience to an order or direction of the Charity Commission

Information I provide to the Charity Commission will be true, complete, and correct.

I understand that it is an offence under section 60(1)(b) of the Charities Act 2011 to provide false or misleading information knowingly or recklessly.

I will comply with my responsibilities as a Trustee – set out in the Charity Commission guidance ‘The Essential Trustee’.