Name of Organisation4th Ashby Scout Group
Name of individual  
Role in the organisation

I, the undersigned, declare that:  

  • I am not disqualified from acting as a charity trustee  
  • I have not been convicted of an offence involving deception or dishonesty (or any such conviction is legally regarded as spent)  
  • I have not been involved in tax fraud or other fraudulent behaviour including misrepresentation and/or identity theft
  • I have not used a tax avoidance scheme featuring charitable reliefs or using a charity to facilitate the avoidance  
  • I have not been involved in designing and /or promoting tax avoidance schemes
  • I am not an undischarged bankrupt  
  • I have not made compositions or arrangements with my creditors from which I have not been discharged  
  • I have not been removed from serving as a charity trustee, or been stopped from acting in a management position within a charity  
  • I have not been disqualified from serving as a Company Director  
  • I will at all times seek to ensure the charity’s funds, and charity tax reliefs received by this organisation, are used only for charitable purposes  


Home Address

Previous Address (if moved in past 12mths)

Date of Birth

National Insurance Number or National Identity Card Number

If you have signed this declaration but want to make any information known or clarify any points please add them in the space provided