Financial Disclosure Form


A financial disclosure form is needed to disclose or prove the various types of assets – financial and non-financial possessed by an individual. A financial disclosure form can be used for several purposes. Various segments available in a financial disclosure form include details about shares, other financial investments, directorship and partnership in any firm, remuneration inside and outside the public service, sponsorships, gifts, details on land and property, etc. So the financial disclosure form furnishes total details of the capital possessed by a person. You could get more details on the form in the following sample financial disclosure form.

Sample Financial Disclosure Form

 

Financial Disclosure form

CONFIDENTIAL

I, the undersigned ____________

Postal Address: __________________________________________________________

Residential Address: ______________________________________________________

Position held: _________________________

Name of the department: ________________

Telephone number: ____________________

Fax: _______________

hereby certify that the following information is complete and correct to the best of my knowledge.

Shares and other financial investments

No. of shares Nature Nominal value Name of the company
       
       
       
       

Directorship and Partnerships

Name of corporate entity or partnership Type of Business Amount of remuneration
     
     
     
     

Remunerated work outside public service

Name of the employer Type of work Amount of remuneration
     
     
     
     

 

Name of the executing authority: ________________

Portfolio: ___________________

Signature of executing authority: ________________

Date: ________________

Consultancies and retainer ships

Name of the client Nature Type of business activity Value of benefits received
       
       
       
       

Sponsorships

Source of assistance / sponsorship Description of assistance / sponsorship Value of assistance / sponsorship
     
     
     
     

Gifts and hospitality from a source other than a family member

Description Value Source
     
     
     
     

Land and Property

Description Extent Area Value
       
       
       
       

 

Signature of the designated employee: ________________

Date: _________

Place: __________


Category: Financial Forms

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