B.C. Reg. 453/98
O.C. 1538/98		 Deposited December 15, 1998
This archived regulation consolidation is current to August 5, 2005 and includes changes enacted and in force by that date. For the most current information, click here.

Members' Conflict of Interest Act

MEMBERS' CONFLICT OF INTEREST REGULATION

[includes amendments up to B.C. Reg. 377/99]

Contents
  1  Prescribed forms
  Appendix: Members' General Instructions
    Form 1— Member's Disclosure Statement
    Form 2 — Member's Declaration
    Form 3 — Private Corporation Statement
    Form 4 — Member's Statement of Material Change
    Form 5 — Member's Statement of Gifts and Personal Benefits

Prescribed forms

1 The regulation in the attached Appendix is made.

Appendix

Conflict of Interest Disclosure Forms

Member's General Instructions

Members' Conflict of Interest Act

Dear Member:

Read carefully the following guidelines and definitions prior to completing the Conflict of Interest Disclosure Forms. Each of the forms outlines a series of questions. Please answer each question and if necessary supply the additional information required. Should you have questions concerning these guidelines, or have difficulty completing any of the forms, please contact the Conflict of Interest Commissioner. If you do not have enough space to complete any item in any of the forms, please attach a separate sheet. Additional forms and copies of individual sheets are available at the Commissioner's Office.

On receipt of your Confidential Disclosure Statements, and prior to the preparation of your Public Disclosure Statement by the Commissioner, you can expect the Office of the Commissioner to schedule a personal interview with you, your spouse (if available) and the Commissioner.

General Guidelines

Form 1: Member's Disclosure Statement

Complete the following five sections:

In answering the specifics of certain questions, a condition of joint ownership or liability may apply. If ownership or liability is joint, specify for each family member to whom ownership or liability applies.

Form 2: Member's Conflict of Interest Declaration

On completing the Member's Disclosure Statement (form 1) and Private Corporation Statement (form 3, if applicable), you are also required to sign the declaration stating you are familiar with the requirements of the Members' Conflict of Interest Act and that you have accurately disclosed all necessary information.

Form 3: Private Corporation Statement

You are required to complete form 3 for each private corporation and its affiliates controlled by you or a member of your family. Form 3 may be obtained at the Office of the Commissioner.

Form 4: Material Change

You are required to file a material change form with the Conflict of Interest Commissioner within 30 days of acquisition or disposition of any asset, liability, financial interest or source of income of you or a member of your family. Material change also applies to any private corporation controlled by yourself, your spouse or minor children.

Form 5: Member's Statement of Gifts and Personal Benefits

You are required to complete a Statement of Gifts and Personal Benefits (form 5) if you or a member of your family have accepted a gift or personal benefit that exceeds $250 and is connected directly or indirectly with the performance of the duties of your office.

Definitions

In each of the Disclosure Statements:

"child" includes a person to whom a member has demonstrated a settled intention to treat as a child of his or her family;

"commissioner" means the person appointed under section 14 of the Members' Conflict of Interest Act;

"insider" is someone who owns more than 10% of the voting shares or is a director or senior officer of a corporation;

"material change" means an acquisition or disposition, whether in whole or in part, occurring after a member files a disclosure statement, of any asset, liability, financial interest or source of income by a member, the member's spouse or a minor child of the member, or a private corporation controlled by any of them or any combination of them, except

a) an asset, liability or financial interest of less than $1,000 in value,

b) a source of income of less than $1,000,

c) personal property used for transportation, household, educational, recreational, social or aesthetic purposes,

d) cash on hand or on deposit with a financial institution in Canada that is lawfully entitled to accept deposits,

e) fixed value securities issued by any government or municipality in Canada or any agency thereof,

f) one arising within a mutual fund, investment fund or segregated fund, whether within or without an RRSP or RRIF, that has previously been disclosed,

g) a guaranteed investment certificate or similar financial instrument, or

h) an annuity, life insurance policy, pension right or educational savings plan;

"member" means a member of the Legislative Assembly or of the Executive Council, or both;

"member of your family" refers to your spouse and minor children;

"mortgagee" refers to the lender of the mortgage funds who holds the mortgage;

"mortgagor" refers to the holder of the mortgage or one who owes money on a mortgage. Mortgagor does not mean money owed from late payments.

"private corporation" means a corporation, all of whose issued and outstanding securities are subject to restrictions on transfer and are beneficially owned directly or indirectly by not more than 50 persons;

"private interest" does not include an interest arising from the exercise of an official power or the performance of an official duty or function that

a) applies to the general public,

b) affects a member as one of a broad class of electors, or

c) concerns the remuneration and benefits of a member or an officer or employee of the Legislative Assembly;

"public corporation" means that it is not a private corporation;

"self directed RRSP" is an RRSP where you have appointed a trustee with whom you deposit your contributions and who invests this money in securities which you select or as you direct;

"non-self directed RRSP" is an RRSP where contributions are made to a financial agent, bank or broker who invests the money in securities selected by the agent;

"spouse" means a person who is married to a member or a person who is living with a member as husband and wife but does not include a husband or a wife who is separated and living apart from a member and who

a) has entered into a written agreement under which they have agreed to live apart, or

b) is subject to an order of the court recognizing the separation.

Form 1

Confidential

Member's Disclosure Statement

 

Members' Conflict of Interest Act

 

 

.....................................................................
Name of member

.....................................................................
Signature of member

.....................................................................
Date of disclosure

PART A

General Information

A-1 Contact Information

A.  Home address   Phone number   Fax number
  ....................................................   ...........................   ...........................
  ....................................................   E-mail address
  ....................................................   ..............................................................
B. Legislature address   Phone number   Fax number
  ....................................................   ...........................   ...........................
  ....................................................   E-mail address
  ....................................................   ..............................................................
C. Constituency address   Phone number   Fax number
  ....................................................   ...........................   ...........................
  ....................................................   E-mail address
  ....................................................   ..............................................................

A-2 Family Information

....................................................................................
A. Do you have a spouse?  [ ] yes [ ] no
If yes, what is your spouse's name? ...............................................................................
B. Do you have children under the age of 19? [ ] yes [ ] no
If yes, list their names and birthdates below:
Name Birthdate
...........................................
.................................................................................... ...........................................
.................................................................................... ...........................................
Please attach separate sheet if needed

A-3 Private Corporation Ownership

A.  Do you, your spouse or your children under the age of 19, or any combination 
of you, control one or more private corporations?		 [ ] yes [ ] no
If yes, complete FORM 3 and in addition complete the following for each corporation:
 
1. Private Corporation
Name of corporation   Address
........................................................................   ..............................................................................
........................................................................   ..............................................................................
Nature of business   Affiliated corporation
........................................................................   ..............................................................................
........................................................................   ..............................................................................
•  Does this corporation have any business contracts or receive benefits from the Government of British Columbia? [ ] yes [ ] no
If yes, describe:
...............................................................................................................................................................
...............................................................................................................................................................
 
2. Private Corporation
Name of corporation   Address
........................................................................   ..............................................................................
........................................................................   ..............................................................................
Nature of business   Affiliated corporation
........................................................................   ..............................................................................
........................................................................   ..............................................................................
•  Does this corporation have any business contracts or receive benefits from the
Government of British Columbia?		 [ ] yes [ ] no
If yes, describe:
...............................................................................................................................................................
...............................................................................................................................................................
Please attach separate sheet for additional corporations

PART B

Statement of Assets

B-1 Common Financial Interests

A. Do you or a member of your family have any assets?  [ ] yes [ ] no

If yes indicate (x) in the following categories:

  Asset category   Member   Spouse   Child(ren)
1.  Bank and other deposits   [ ]   [ ]   [ ]
2.  Government bonds and securities   [ ]   [ ]   [ ]
3.  Guaranteed Investment Certificates or debentures   [ ]   [ ]   [ ]
4.  Pension rights   [ ]   [ ]   [ ]
5.  Annuities   [ ]   [ ]   [ ]
6.  Life insurance policies with a cash surrender value   [ ]   [ ]   [ ]
7.  Registered Educational Savings Plans
with a cash surrender value		   [ ]   [ ]   [ ]

B-2 Mutual/Segregated Funds

A.  Do you or a member of your family hold mutual funds and/or
segregated funds (Other than those contained in RRSPs and RRIFs)?		   [ ] yes [ ] no

 If yes, complete the following and indicate () the holder of each fund.
(M=Member, S=Spouse, C=Child(ren)):

M  S  C Fund name Fund administrator
[ ]  [ ]  [ ] .................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................
[ ]  [ ]  [ ] ..................................................... .....................................................

Please attach most recent list of assets or a fund statement as supplied by the fund administrator/manager

B-3 Registered Retirement Savings Plans (RRSPs)

D.  Do you or your spouse have an RRSP?    [ ] yes [ ] no

If yes, complete the following for each RRSP plan (M=Member, S=Spouse;
Y=Yes, N=No):

Plan
Number		     Owner ()      Spousal ()   Self ()
administered?		 Trustee
name
    M S       Y N  
1.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
2.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
3.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
4.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
5.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
6.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
7.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
8.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
9.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
10.    [ ] [ ]   [ ]   [ ] [ ] ................................................................
11.    [ ] [ ]   [ ]   [ ] [ ] ................................................................

Please attach separate sheet for additional plans

B-4 RRSP: Deposit and Bond Details

A.  Within any of your RRSPs do you have any money on deposit
(including term deposits and/or general investment certificates)?		    [ ] yes [ ] no

If yes, indicate in the box below the plan number for each deposit and/or certificate
(Plan # as shown in B3-D):

Plan # [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____]

B.  Within any of your RRSPs do you have any government or
government guaranteed bonds?		    [ ] yes [ ] no

If yes, indicate in the box below the plan number for each bond
(Plan # as shown in B-3D):

Plan # [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____] [_____]

C.  Within any of your RRSPs do you have any other bonds?    [ ] yes [ ] no

If yes, indicate the plan number and the name of the corporation or institution which issued the bond:

Plan # (i.e. 1, 2 etc) Name of corporation or institution
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................

Please attach separate sheet for additional RRSPs

B-5 RRSP: Other Investment

D.  Do you hold within your RRSP any shares and/or other
interests in corporations?		    [ ] yes [ ] no

If yes, indicate the plan number and the name of the corporation or institution in which the investment is made:

Plan # Name of corporation or institution
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................

Please attach separate sheet if needed

B-5 RRSP Continued

B.  Do you hold within your RRSP any mutual funds or segregated funds?   [ ] yes [ ] no

If yes, please indicate the plan number and the name of each fund:

Plan # Name of fund
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................

Please provide a list of assets in each of the funds as provided by the fund administrator/manager

C.  Do you hold within your RRSP any mortgage investments?   [ ] yes [ ] no

If yes, indicate the plan number and the name of the corporation in which the investment is made:

Plan # Name of fund
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................
........................................ .........................................................................................

 

D.  Do you hold within your RRSP a National Housing Act mortgage backed security?   [ ] yes [ ] no

Please attach separate sheet if needed

B-6 Registered Retirement Income Funds (RRIFs)

A.  Do you or your spouse have any RRIFs?   [ ] yes [ ] no

If yes, complete the following for each RRIF plan:

Plan
number		 Owner ()
Member Spouse		 Spousal ()
RRIF		 Financial institution name
........................ [ ]  [ ] [ ] ...............................................................
........................ [ ]  [ ] [ ] ...............................................................
........................ [ ]  [ ] [ ] ...............................................................
........................ [ ]  [ ] [ ] ...............................................................

Please attach separate sheet if needed

B-7 Other Common Financial Interests

A.  Do you or a member of your family have any other financial interests which
do not conveniently fit within the asset categories provided in B-1?		    [ ] yes [ ] no

If yes, list details:

...................................................................................................................................................

...................................................................................................................................................

...................................................................................................................................................

...................................................................................................................................................

...................................................................................................................................................

...................................................................................................................................................

Please attach separate sheet if needed

B-8 Real Property Interests

A.  Are you or a member of your family a registered owner of residential
property that is primarily occupied by you or a member of your family?		   [ ] yes [ ] no

If yes, complete the following:

  Owner ()
Member Spouse		   Address   Legal
description
1. [ ]  [ ]   .........................................................................   ......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
2. [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................

 

B.  Are you or a member of your family the registered owner of recreational
property that is primarily used by you or a member of your family?		   [ ] yes [ ] no

If yes, complete the following:

  Owner ()
Member Spouse		   Address   Legal
description
1. [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
2. [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................

Please attach separate sheet if needed

B-8 Continued

C.  Are you or a member of your family the registered owner of other land and improvements?   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

  Owner ()
M  S  C ()		   Address and legal description   Name of debtor
1. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
2. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
3. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................

 

D.  Are you or a member of your family the holder (i.e. mortgagee) of a
mortgage or an agreement for sale from someone else?		   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

  Owner ()
M  S  C ()		   Address and legal description   Name of debtor
1. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
2. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................

Please attach separate sheet if needed

B-8 Continued

E.  Do you or a member of your family hold a lease as either owner or tenant?   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

  M  S  C  ()   Address of property   Owner Tenant ()
1. [ ]  [ ]  [ ]   .........................................................................   [ ]  [ ]
      .........................................................................    
      .........................................................................    
2. [ ]  [ ]  [ ]   .........................................................................   [ ]  [ ]
      .........................................................................    
      .........................................................................    
3. [ ]  [ ]  [ ]   .........................................................................   [ ]  [ ]
      .........................................................................    
      .........................................................................    
4. [ ]  [ ]  [ ]   .........................................................................   [ ]  [ ]
      .........................................................................    
      .........................................................................    

Please attach separate sheet if needed

F.  Do you or a member of your family have other interests in relation
to land held by you or a member of your family (i.e. mineral claims
and leases, grazing permits and other similar interests)?		   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

  M  S  C  ()   Location of land   Name of interest
1. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
2. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
3. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................
4. [ ]  [ ]  [ ]   .........................................................................   .......................................
      .........................................................................   .......................................
      .........................................................................   .......................................

Please attach separate sheet if needed

B-9 Shares, Securities and Other Interests in Public Corporations

A.  Do you or members of your family hold shares, securities or other interests in a public corporation?
[You need not include qualifying (membership) shares in a credit union or cooperative, but must include such things as bonds, debentures and stock options.]		   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

  M  S  C  ()   Name of corporation   Type of interest
1. [ ]  [ ]  [ ]   .........................................................................   .......................................
2. [ ]  [ ]  [ ]   .........................................................................   .......................................
3. [ ]  [ ]  [ ]   .........................................................................   .......................................
4. [ ]  [ ]  [ ]   .........................................................................   .......................................
5. [ ]  [ ]  [ ]   .........................................................................   .......................................
6. [ ]  [ ]  [ ]   .........................................................................   .......................................
7. [ ]  [ ]  [ ]   .........................................................................   .......................................

Please attach separate sheet if needed

B-9 Continued

B.  Are you or a member of your family an "insider" (an insider is someone
who owns more than 10% of the voting shares or is a director or senior officer of a corporation) in any of the corporations identified in B-9A?		   [ ] yes [ ] no

If yes, indicate () which family member and corporations (M=Member, S=Spouse, C=Child(ren)):

  M  S  C  ()   Name of corporation   % of Total shares
1. [ ]  [ ]  [ ]   .........................................................................   .......................................
2. [ ]  [ ]  [ ]   .........................................................................   .......................................
3. [ ]  [ ]  [ ]   .........................................................................   .......................................
4. [ ]  [ ]  [ ]   .........................................................................   .......................................
5. [ ]  [ ]  [ ]   .........................................................................   .......................................
6. [ ]  [ ]  [ ]   .........................................................................   .......................................
7. [ ]  [ ]  [ ]   .........................................................................   .......................................
8. [ ]  [ ]  [ ]   .........................................................................   .......................................

Please attach separate sheet if needed

B-10 Private Business Interests

A.  Do you or a member of your family hold shares or debt interests in private
corporations, interests in sole proprietorships, partnerships or joint
ventures (other than private corporations identified in FORM 3)?		   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Name and nature of business   Description of interest owned
[ ]  [ ]  [ ]   .........................................................................   .......................................
    .........................................................................   .......................................
    .........................................................................   .......................................
[ ]  [ ]  [ ]   .........................................................................   .......................................
    .........................................................................   .......................................
    .........................................................................   .......................................
[ ]  [ ]  [ ]   .........................................................................   .......................................
    .........................................................................   .......................................
    .........................................................................   .......................................

Please attach separate sheet if needed

B-11 Trust Property

A.  Are you or a member of your family the beneficiary of a trust that holds property?   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Name of trustee   Nature of trust property
[ ]  [ ]  [ ]   .........................................................................   .......................................
    .........................................................................   .......................................
[ ]  [ ]  [ ]   .........................................................................   .......................................
    .........................................................................   .......................................

Please attach separate sheet if needed

B-12 Guarantees

A.  Have you received any financial guarantee in your favour or
in favour of a member of your family?		   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Name and address of guarantor
[ ]  [ ]  [ ]   ........................................................................................................ .......
    ........................................................................................................ .......
    ........................................................................................................ .......
[ ]  [ ]  [ ]   ........................................................................................................ .......
    ........................................................................................................ .......
    ........................................................................................................ .......

Please attach additional sheet if needed

B-13 All Other Assets

A.  Do you or a member of your family own any other assets not previously listed?   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Nature of asset
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................

Please attach separate sheet if needed

PART C

Statement of Liabilities

C-1 Mortgages

A.  Do you or members of your family owe money under a mortgage
or a similar obligation?		   [ ] yes [ ] no

If yes, please complete the following (M=Member, S=Spouse, C=Child(ren)):

  M  S  C  ()   Address and legal description of mortgaged property
1. [ ]  [ ]  [ ]   ...............................................................................................................
      ...............................................................................................................
      Name and address of mortgagee (lender)
      ...............................................................................................................
      ...............................................................................................................
  M  S  C  ()   Address and legal description of mortgaged property
2. [ ]  [ ]  [ ]   ...............................................................................................................
      ...............................................................................................................
      Name and address of mortgagee (lender)
      ................................................................................................................
      ................................................................................................................

Please attach separate sheet if needed

C-2 Loans

A.  Do you or a member of your family owe money to creditors other than
on mortgages?		   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Name and address of creditor
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................

Please attach separate sheet if needed

C-3 Guarantees

A.  Have you or a member of your family given guarantees (e.g. co-signed a loan) for anyone?   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Name and address of creditor
[ ]  [ ]  [ ]   ...............................................................................................................
    ...............................................................................................................
    Name and address of principal debtor
    ...............................................................................................................
    ...............................................................................................................
    Name and address of creditor
[ ]  [ ]  [ ]   ................................................................................................................
    ...............................................................................................................
    Name and address of principal debtor
    ...............................................................................................................
    ...............................................................................................................
    Name and address of creditor
[ ]  [ ]  [ ]   ...............................................................................................................
    ........................................................................................................ .......
    Name and address of principal debtor
    ........................................................................................................ .......
    ........................................................................................................ .......

Please attach separate sheet if needed

C-4 Other Liabilities

A.  Do you or members of your family have any other liabilities (other than delinquent taxes)? [You need not disclose commercial accounts and credit card indebtedness for less than 60 days and which you expect to pay within 60 days.]   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Description of liability
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
    Name and address of person to whom liability owed
    ................................................................................................................
    ................................................................................................................
    Description of liability
[ ]  [ ]  [ ]   .................................................................................................................
    ................................................................................................................
    Name and address of person to whom liability owed
    ................................................................................................................
    ................................................................................................................

Please attach separate sheet if needed

C-5 Delinquent Taxes

A.  Do you or a member of your family owe any delinquent taxes including overdue land taxes and unpaid income tax?   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Description of delinquent taxes
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   ................................................................................................................
    ................................................................................................................
    ................................................................................................................
[ ]  [ ]  [ ]   .................................................................................................................
    ................................................................................................................
    ................................................................................................................

Please attach additional sheet if needed

PART D

Sources of Income

D-1 Income from the Province of British Columbia

A.  Have you or a member of your family received income from any ministry,
agency, board or commission of the Province of British Columbia during the last 12 months?		   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Source   Type of income
(Who paid it to you?)
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................

Please attach separate sheet if needed

D-2 Income from All Other Sources

A.  Have you or a member of your family received income from any other sources during the last 12 months? [Include income from any person, corporation or subsidiary, partnership or organization for services performed as an officer, director, manager, proprietor, partner or employee.]   [ ] yes [ ] no

If yes, complete the following (M=Member, S=Spouse, C=Child(ren)):

M  S  C  ()   Source   Type of income
(Who paid it to you?)
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................

Please attach separate sheet if needed

PART E

Executive Council Members Only

E-1 Employment, Profession or Business

A.  Are you or your spouse or minor children engaged in any employment or profession or business in addition to your duties as a member of the Legislative Assembly and Executive Council? 
    Member [ ] yes [ ] no
    Spouse [ ] yes [ ] no
    Child(ren) [ ] yes [ ] no

If yes, what is the nature of the employment, profession or business?
[Please complete for each Member, Spouse and Child(ren)]

    Member
Name of employment,
profession or business		   ................................................................................................................
  ................................................................................................................
     
Address of employment,
profession or business		   .................................................................................................................
  .................................................................................................................
     
Nature of employment,
profession or business		   .................................................................................................................
  .................................................................................................................
    Spouse
Name of employment,
profession or business		   .................................................................................................................
  .................................................................................................................
     
Address of employment,
profession or business		   .................................................................................................................
  .................................................................................................................
     
Nature of employment,
profession or business		   .................................................................................................................
  .................................................................................................................

Please attach separate sheet if needed

E-1 Continued

    Child(ren)
Name of employment,
profession or business		   .................................................................................................................
  .................................................................................................................
     
Address of employment,
profession or business		   .................................................................................................................
  .................................................................................................................
     
Nature of employment,
profession or business		   .................................................................................................................
  .................................................................................................................

Please attach separate sheet if needed

E-2 Current Relationship

A.  What is the current relationship you, your spouse or your minor children have with respect to an employment, profession or business identified in question E-1?   [ ] yes [ ] no

 

Nature of relationship   Member Spouse Child(ren)
    Yes  No Yes  No Yes  No
Working full time or part time?   [ ]  [ ] [ ]  [ ] [ ]  [ ]
On leave of absence or sabbatical?   [ ]  [ ] [ ]  [ ] [ ]  [ ]
In receipt of benefits?   [ ]  [ ] [ ]  [ ] [ ]  [ ]
(please specify) ........................................................................................
  ........................................................................................
Eligible for deferred benefits?   [ ]  [ ] [ ]  [ ] [ ]  [ ]
(please specify) ........................................................................................
  ........................................................................................
Other   [ ]  [ ] [ ]  [ ] [ ]  [ ]
(please specify) ........................................................................................
  ........................................................................................
  ........................................................................................

Please attach separate sheet if needed

E-3 Offices and Directorships

A.  Do you hold an office or directorship? [Other than in a social club (i.e. a group formed with the principal purpose of promoting and providing for social purposes), religious organization, political party or Crown corporation.]   [ ] yes [ ] no

If yes, identify the organization and list the Offices (O) or Directorships (D) held:

Organization List of O or D held
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................

Please attach separate sheet if needed

Form 2

Member's Declaration

Members' Conflict of Interest Act

(as of ...........................................)
      date declaration signed

Name of Member:

..........................................................................

 

I am familiar with the requirements of the Members' Conflict of Interest Act. My attached confidential Disclosure Statement, to the best of my knowledge, information and belief, accurately discloses all assets, liabilities, financial interests and sources of income of me, my spouse (if any) and my children under age 19 including a child to whom I have demonstrated a settled intention to treat the child as a child of my family (if any), and particulars of private corporations controlled by any of us, or a combination of us (if any), and all other information required by the Disclosure Statement.

..........................................
Date of disclosure		   .........................................................
Signature of Member
 
...........................................................
Signature of Commissioner		   ...........................................................
Date of meeting with Commissioner
 

 

Form 3
[am. B.C. Reg. 377/99.]

Private Corporation Statement

 

Members' Conflict of Interest Act

 

 

.................................................................................
Name of corporation

 

.................................................................................
Name of member

 

.................................................................................
Signature of member

 

.................................................................................
Date of disclosure

PART A

Statement of Corporate Assets

A-1 Common Financial Interests

A.  Does this corporation have any of the following assets?   [ ] yes [ ] no

If yes, indicate () in the following categories:

  Asset category  
1.  Bank and other deposits   [ ]
2.  Government bonds and securities
(securities issued or guaranteed by Canada,
a province or local government)		   [ ]
3.  Guaranteed Investment Certificates or debentures   [ ]
4.  Mutual funds, investment funds or segregated funds   [ ]

 

A-2 Real Property Interests

A.  Is this corporation a registered owner of land and/or improvements?   [ ] yes [ ] no

If yes, complete the following:

Address Legal description
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................

 

B.  Does this corporation have mortgages or agreements for sale either as a
mortgagee or vendor (under an agreement for sale)?		   [ ] yes [ ] no

If yes, complete the following (M=Mortgage, A=Agreement for sale):

  Identify ()
M  A		 Address   Legal description
1. [ ]  [ ] ....................................................................   ....................................................
    .................................................... ................   ....................................................
    Name of debtor    
    ............................................................................  
    Address   Legal description
2. [ ]  [ ] .................................................... ................   ....................................................
    .................................................... ................   ....................................................
    Name of debtor    
    ............................................................................  

Please attach separate sheet if needed

A-2 Continued

C.  Does this corporation hold interests as either owner or tenant?   [ ] yes [ ] no

If yes, complete the following:

Address of property Owner Tenant ()
...........................................................................................    
........................................................................................... [ ] [ ]
...........................................................................................    
...........................................................................................    
........................................................................................... [ ] [ ]
...........................................................................................    
...........................................................................................    
........................................................................................... [ ] [ ]
...........................................................................................    

 

D.  Does this corporation have other interests in relation to land
(eg. mineral claims and leases, grazing permits and other similar interests?)		   [ ] yes [ ] no

If yes, complete the following:

  Location of land   Nature of interest
1. ...............................................................................   ........................................................
  ...............................................................................   ........................................................
2. ...............................................................................   ........................................................
  ...............................................................................   ........................................................

Please attach separate sheet if needed

A-3 Shares and Securities and Other Interests in Corporations

A.  Does this Corporation hold shares, securities or other interests in any other Corporation? [You need not include qualifying (membership) shares in a credit union or cooperative, but must include such things as bonds, debentures and stock options.]   [ ] yes [ ] no

If yes, complete the following:

Name of corporation   Type of interest
...............................................................................   ............................................................
...............................................................................   .............................................................
...............................................................................   .............................................................
...............................................................................   .............................................................

B.  Give the name of any corporation that is an affiliate of a corporation listed above:

....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................

Please attach separate sheet if needed

A-4 Other Business Interests

A.  Does this corporation have any interests in partnership (P) or joint venture (J) agreements?   [ ] yes [ ] no

If yes, indicate () below:

P  J  () Description of business   Address or location
[ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................   ........................................................
  ...............................................................................   ........................................................
[ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................   ........................................................
  ...............................................................................   ........................................................
[ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................   ........................................................
  ...............................................................................   ........................................................

Please attach separate sheet if needed

A-5 Trust Property

A.  Is this corporation the beneficiary of a trust that holds property for it?   [ ] yes [ ] no

If yes, complete the following:

Name of trustee Nature of trust property
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................

Please attach separate sheet if needed

A-6 Guarantees

A.  Has this corporation received any financial guarantees?   [ ] yes [ ] no

If yes, complete the name and address of the guarantor:

Name   Address
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................

Please attach additional sheet if needed

A-7 All Other Assets

A.  Does this corporation own any other assets not previously listed?   [ ] yes [ ] no

If yes, list and describe the nature of the financial interest:

Nature of financial interest
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................

Please attach separate sheet if needed

PART B

Statement of Liabilities

B-1 Mortgages

A.  Does this corporation owe money in respect to a mortgage or some similar obligation?   [ ] yes [ ] no

If yes, complete the following (M=Mortgage, O=Other):

M  O  ()   Address and legal description of mortgaged property
[ ]  [ ]   ................................................................................................................
    ................................................................................................................
    Name and address of mortgagee (e.g. lender)
    ................................................................................................................
    ................................................................................................................
    Address and legal description of mortgaged property
[ ]  [ ]   .................................................................................................................
    ................................................................................................................
    Name and address of mortgagee (e.g. lender)
    ................................................................................................................
    ................................................................................................................

Please attach separate sheet if needed

B-2 Loans

A.  Does this corporation owe money to creditors other than on mortgages?   [ ] yes [ ] no

If yes, identify the name and address of each creditor:

Name   Address
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................

Please attach separate sheet if needed

B-3 Guarantees

A.  Has this corporation given financial guarantees?   [ ] yes [ ] no

If yes, complete the following:

Name and address of creditor
...................................................................................................................................................
...................................................................................................................................................
Name and address of principal debtor
...................................................................................................................................................
...................................................................................................................................................

Please attach separate sheet if needed

B-4 Other Liabilities

A.  Does this corporation have any other liabilities (other than delinquent taxes)? [You need not disclose commercial accounts and credit card indebtedness for less than 60 days and which you expect to pay within 60 days.]   [ ] yes [ ] no

If yes, describe the liability and the name and address of the person to whom liability is owed:

1. Description of liability
...................................................................................................................................................
...................................................................................................................................................
Name and address of person to whom liability owed
...................................................................................................................................................
...................................................................................................................................................
2. Description of liability
...................................................................................................................................................
...................................................................................................................................................
Name and address of person to whom liability owed
...................................................................................................................................................
...................................................................................................................................................

 

B.  Does this corporation owe any delinquent taxes including overdue land taxes and unpaid income tax?   [ ] yes [ ] no

If yes, describe the delinquent taxes:

...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................

Please attach additional sheet if needed

PART C

Statement of Sources of Income

C-1 Income from the Province of British Columbia

A.  Has this corporation received income from any ministry, agency, board or commission of the Province of British Columbia during the last 12 months?   [ ] yes [ ] no

If yes, complete the following:

Source
(Who paid it to the corporation?)		   Type of income
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................

Please attach separate sheet if needed

C-2 Income from all Other Sources

A.  Has this corporation received income from any other source during
the last 12 months?		   [ ] yes [ ] no

If yes, complete the following:

Source
(Who paid it to the corporation?)		   Type of income
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................
.....................................................................   .....................................................................

Please attach separate sheet if needed

PART D

Private Corporation

Ownership Interests

D-1 Shares

A.  Please identify percentage of voting and non-voting shares in this private corporation (M=member, S=Spouse, C=Child(ren)):

 

M  S  C  () % Voting shares   % Non-voting shares
[ ]  [ ]  [ ] ...........................................................   ..............................................................
[ ]  [ ]  [ ] ...........................................................   ..............................................................
[ ]  [ ]  [ ] ...........................................................   ..............................................................
[ ]  [ ]  [ ] ...........................................................   ..............................................................
[ ]  [ ]  [ ] ...........................................................   ..............................................................
[ ]  [ ]  [ ] ...........................................................   ..............................................................
[ ]  [ ]  [ ] ...........................................................   ..............................................................

Please attach separate sheet if needed

D-2 Officers and Directors

A.  List officers and directors of this privately controlled corporation. (O=Officer, D=Director):

 

O  D  () Names   Position held
[ ]  [ ] ...............................................................................   ........................................................
[ ]  [ ] ...............................................................................   ........................................................
[ ]  [ ] ...............................................................................   ........................................................
[ ]  [ ] ...............................................................................   ........................................................
[ ]  [ ] ...............................................................................   ........................................................
[ ]  [ ] ...............................................................................   ........................................................

Please attach separate sheet if needed

 

Form 4

Member's Statement of Material Change

Members' Conflict of Interest Act

Dear Member:

You are required to file any *material change with the Conflict of Interest Commissioner within 30 days of acquisition or disposition of any asset, liability, financial interest or source of income of you, your spouse or your minor children. Material change also applies to any private corporation controlled by you, your spouse or your minor children.

*For the purpose of this form, material change means an acquisition or disposition, other than in the regular way of the company's trade or business, whether in whole or in part, occurring after a member files a disclosure statement, of any asset, liability, financial interest or source of income by a member, the member's spouse or a minor child of the member, or a private corporation controlled by any of them or any combination of them, except

a) an asset, liability or financial interest of less than $1,000 in value,

b) a source of income of less than $1,000,

c) personal property used for transportation, household, educational, recreational, social or aesthetic purposes,

d) cash on hand or on deposit with a financial institution in Canada that is lawfully entitled to accept deposits,

e) fixed value securities issued by any government or municipality in Canada or any agency thereof,

f) one arising within a mutual fund, investment fund or segregated fund, whether within or without an RRSP or RRIF, that has been previously disclosed,

g) a guaranteed investment certificate or similar financial instrument, or

h) an annuity, life insurance policy, pension right or educational savings plan.

•  Have you had any material changes since filing your last Member's Declaration form?   [ ] yes [ ] no

If yes, complete this form.

PART A
Acquisitions

A-1 Assets, Liabilities or Financial Interests

Please complete the following and indicate the nature and date of acquisition of each asset, liability or financial interest since your last filing
(M=Member, S=Spouse, or C=Child(ren)):

M  S  C  () Nature of acquisition   Date of acquisition
[ ]  [ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................    
  ...............................................................................    
  ...............................................................................    
[ ]  [ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................    .
  ...............................................................................    
  ...............................................................................    
[ ]  [ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................    
  ...............................................................................    
  ...............................................................................    

Please attach separate sheet if needed

A-2 Private Corporations

A.  Please complete the following and indicate the nature and date of acquisition for each privately controlled corporation since your last filing (M=Member, S=Spouse, or C=Child(ren)):

 

M  S  C  () Nature of acquisition   Date of acquisition
[ ]  [ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................    
  ...............................................................................    
  ...............................................................................    
[ ]  [ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................    
  ...............................................................................    
  ...............................................................................    
[ ]  [ ]  [ ] ...............................................................................   ........................................................
  ...............................................................................    
  ...............................................................................    
  ...............................................................................    
[ ]  [ ]  [ ] ...............................................................................    ........................................................
  ...............................................................................    
  ...............................................................................    
  ...............................................................................    

Please attach separate sheet if needed

PART B
Dispositions

B-1 Assets, Liabilities or Financial Interests

A.  Please complete the following and indicate the nature and the date of disposition of each asset, liability or financial interest since your last filing (M=Member, S=Spouse, or C=Child(ren); T=Total disposition, P=Partial disposition):

 

M  S  C  () Nature of acquisition   T  P ()
[ ]  [ ]  [ ] ...............................................................................   [ ]  [ ]
  ...............................................................................    
  ...............................................................................    Date of disposition
  ...............................................................................   ........................................................
[ ]  [ ]  [ ] ...............................................................................   [ ]  [ ]
  ...............................................................................     
  ...............................................................................    Date of disposition
  ...............................................................................   ........................................................
[ ]  [ ]  [ ] ...............................................................................   [ ]  [ ]
  ...............................................................................    
  ...............................................................................     Date of disposition
  ...............................................................................   ........................................................

Please attach separate sheet if needed

B-2 Private Corporations

A.  Please complete the following and indicate the nature and the date of disposition of each private corporation since your last filing (M=Member, S=Spouse, or C=Child(ren); T=Total disposition, P=Partial disposition):

 

M  S  C  () Nature of acquisition   T  P ()
[ ]  [ ]  [ ] ...............................................................................   [ ]  [ ]
  ...............................................................................    
  ...............................................................................    Date of disposition
  ...............................................................................   ........................................................
[ ]  [ ]  [ ] ...............................................................................   [ ]  [ ]
  ...............................................................................     
  ...............................................................................    Date of disposition
  ...............................................................................   ........................................................
[ ]  [ ]  [ ] ...............................................................................   [ ]  [ ]
  ...............................................................................    
  ...............................................................................   Date of disposition
  ...............................................................................   ........................................................

Please attach separate sheet if needed

PART C

Sources of Income

C-1 Income Greater than $1,000

A.  Please complete the following and indicate any change in source and/or income since last filing (M=Member, S=Spouse, or C=Child(ren)):

 

M  S  C  ()   Source of income
(who paid it to you?)		   Type of income
(e.g. employment, business,
investments, etc.)
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................
[ ]  [ ]  [ ]   .........................................................   .........................................................
    .........................................................   .........................................................

Please attach separate sheet if needed

I certify that this statement, to the best of my knowledge, information and belief, discloses all material changes in the assets, liabilities, financial interests and sources of income of myself and my spouse and my minor children and any private corporations controlled by me or my spouse or minor children or any combination of us.

 

.................................................................................
Name of member

 

.................................................................................
Signature of member

 

Date of filing ............................................................

Form 5

[am. B.C. Reg. 46/99]

Member's Statement of Gifts and
Personal Benefits

Members' Conflict of Interest Act

Dear Member:

Complete and file this form immediately with the Commissioner appointed under the Members' Conflict of Interest Act if you or a member of your family have accepted a gift or personal benefit that is connected directly or indirectly with the performance of your duties of office, and if

a) the value of the gift or benefit exceeds $250, or

b) the value of all of the gifts and benefits you received directly or indirectly from one source in any 12 month period exceeds $250.

I have received gifts and or personal benefits as described above:           [ ] yes [ ] no

If yes, please complete this form.

I certify that the gifts and benefits declared in this form were received as a result of the responsibilities of my office.

 

.................................................................................
Name of member

 

.................................................................................
Signature of member

 

Date of filing ............................................................

A-1 Gifts and Benefits

A.  If paragraph b) on the previous page applies, list all gifts and benefits accepted by you or a member of your family (M=Member, S=Spouse, C=Child(ren)):

 

  M  S  C  ()   Nature of gift or benefit   Value of gift or benefit
1. [ ]  [ ]  [ ]   .........................................................   .........................................................
      .........................................................   .........................................................
      Name of donor   Date received
      .........................................................   .........................................................
      .........................................................   .........................................................
  M  S  C  ()   Nature of gift or benefit   Value of gift or benefit
2. [ ]  [ ]  [ ]   .........................................................   .........................................................
      .........................................................   .........................................................
      Name of donor   Date received
      .........................................................   .........................................................
      .........................................................   .........................................................
  M  S  C  ()   Nature of gift or benefit   Value of gift or benefit
3. [ ]  [ ]  [ ]   .........................................................   .........................................................
      .........................................................   .........................................................
      Name of donor   Date received
      .........................................................   .........................................................
      .........................................................   .........................................................

Please attach separate sheet if needed

A-1 Continued

B.  Describe briefly the circumstances under which each gift or benefit was given and accepted:

 

Gift #
(as identified in A-1)		   Describe circumstances of gift or benefit
...............................   .....................................................................................................
    .....................................................................................................
    .....................................................................................................
 
...............................   .....................................................................................................
    .....................................................................................................
    .....................................................................................................
 
...............................   .....................................................................................................
    .....................................................................................................
    .....................................................................................................

 

C.  If a gift or benefit listed was received indirectly from a source other than the donors identified, what is the name of the source?

 

Gift #   Name of source
...............................   .....................................................................................................
...............................   .....................................................................................................
...............................   .....................................................................................................
...............................   .....................................................................................................

Please attach separate sheet if needed

Note: this regulation replaces B.C. Reg. 144/96

 

[Provisions of the Members' Conflict of Interest Act, R.S.B.C. 1996, c. 287, relevant to the enactment of this regulation: section 26]

Copyright (c) 2005: Queen's Printer, Victoria, British Columbia, Canada