Register of Pecuniary Interest Form Register of Pecuniary Interests Name(Required) First Last Declarartion(Required) I wish to declare no relevant Pecuniary Interests I wish to declare the following Pecuniary Interests Position in Business (e.g. Employer/Director/Owner)(Required)Nature of Business (e.g. Manufacturer/Supplier/Service Provider)(Required)Name of Company/Organisation(Required)Declared Interest (e.g. Services/Equipment/Staff/Admissions)(Required)Need to declare any additional pecuniary interests?(Required) Yes No Please provide details:(Required)Signature(Required)Date(Required) DD slash MM slash YYYY