Disclosure Statements Regulations

Link to law: https://www.novascotia.ca/just/regulations/regs/cidisstat.htm

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Disclosure Statements Regulations
made under Section 35 of the

Conflict of Interest Act

S.N.S. 2010, c. 35

O.I.C. 2011-114 (March 29, 2011), N.S. Reg. 154/2011

Citation

1     These regulations may be cited as the Disclosure Statements Regulations.

Definition

2     In these regulations, “Act” means the Conflict of Interest Act.

Disclosure statement forms

3     (1)    A disclosure statement filed on behalf of a member under clause 8(1)(a) of the Actmust be in Form A.

 

       (2)    A disclosure statement filed on behalf of a member’s spouse and dependent childrenunder clause 8(1)(b) of the Act must be in Form B.

Form A: Disclosure Statement on Behalf of Member

Province of Nova Scotia

Conflict of Interest Act

 

1)   Statement information

This disclosure statement is filed on behalf of: _______________________________ (type or print name of member in full), a member of the House of Assembly/Executive Council.

 

This statement is an (check one):

[ ]

initial statement

(to be filed within 30 days of becoming a member)

[ ]

annual statement

(to be filed on or before June 30 each year)

[ ]

amended statement

(to be filed within 90 days of acquisition or disposition of asset orliability)

 

2)   Information about member

       a.   Electoral district you represent: ______________________________________

       b.   List of any appointments held by you under [the] Executive Council Act:

 

 

 

c.Your office address:

 

 

 

(street)

(municipality)

(postal code)

 

d.Your permanent residence civic address:

 

 

 

(street)

(municipality)

(postal code)

 

       e.   Your telephone numbers

       •    constituency office: _____ - ______ - __________

       •    caucus office: _____ - ______ - __________

       •    ministerial office: _____ - ______ - __________

       •    permanent residence: _____ - ______ - __________

 

       f.   Name of your spouse:                                                                                                 

Note: “spouse” is defined in the Act as “a person who is married to, the domesticpartner of or living in a conjugal relationship with a member and includes a person of thesame sex as a member, but does not include a person who is separated and living apartfrom a member”.

 

       g.   Names of your dependent children:

 

 

 

Note: “dependent child” is defined in the Act as “a child who is under the age ofmajority or, although over the age of majority, unable, by reason of illness, disability orother cause, to withdraw from the charge of the person’s parents or provide himself orherself with reasonable needs”.

 

3)   Exclusions

You are not required to disclose any of the following in this disclosure statement(subsection 11(3) of the Conflict of Interest Act):

 

       •    assets and financial interests having a value of less than $10,000

       •    a debt you owe to your spouse, a dependent child or a member of your immediatefamily

       •    a debt owed to you by your spouse, a dependent child or a member of your immediatefamily

 

4)   Disclosures

For an amended statement, list only changes since last disclosure statement and indicatewhether they are acquisitions or disposals.

Attach a schedule if there is not enough space on [the] form.

 

You must disclose all of the following information (subsection 11(2) of the Conflict ofInterest Act):

 

       a.   the name of every individual or organization that in any manner whatsoeverremunerates or contributes to you, including any reimbursement for expenses made toyou:

Instructions: Indicate capacity in which remuneration is received and include address ofeach individual or organization named. Do not indicate amount of remuneration orcontributions. Do not list payments included in item j.)

 

Individual ororganization

Civic address

Capacity in whichreceived

 

 

 

 

 

 

 

 

 

 

 

 

 

       b.  the issuer or name of any bonds, debentures, holdings in investment funds, mutualfunds, investment trusts or similar securities you have:

Instructions: Do not include:

       •    Canada Savings Bonds or other investments or securities of fixed value issued orguaranteed by any level of government in Canada or an agency of a government inCanada,

       •    registered retirement savings plans that are not self-directed,

       •    open-ended mutual funds,

       •    guaranteed investment certificates or any similar financial instruments,

       •    annuities and life insurance policies

       •    pension rights

Do not indicate the amount or value.

Name/issuer of bond, debenture etc.

 

 

 

 

       c.   the nature and location of any interest you have in or with respect to real property,whether situate within or outside the Province:

Instructions: Do not include any interest of yours in or with respect to real property thatis used by you, your spouse or your dependent children for residential or recreationalpurposes. Do not list an interest in real property of a corporation of which you are ashareholder.

Location of property

Nature of interest

 

 

 

 

 

 

 

       d.  unless excluded in item b., the name of every corporation, or subsidiary of acorporation, in which you hold a beneficial interest, a share warrant or purchase option:

Instructions: Do not indicate the amount or value.

Name of corporation

 

 

 

 

       e.   the nature of any interest of yours in property of a kind required to be disclosed in itemb., c. or d., and over which you, your spouse or your dependent children have a generalpower of appointment or an expectancy under a trust:

Nature of interest in disclosed property

 

 

 

 

       f.   any trust established for you, and the names of the trustees and the contributors to thetrust:

Name of trust

Contributors to trust

 Trustees

Address for trustees

 

 

 

 

 

 

 

 

 

 

 

 

 

       g.   the name of every individual or organization to which you are financially indebted,

Instructions: Do not include a debt that

       •    is a current and ordinary household and personal living expense of yours or yourspouse or your dependent children

       •    is in respect of an automobile, a boat used for recreational purposes, or recreationalvehicles of yours or your spouse or your dependent children

       •    is money or other property entrusted to or received by you in trust for a person otherthan you or your spouse or your dependent children

       •    is in respect of an interest of yours that is not required to be disclosed in item b. or c.

       •    is less than $10,000

Do not indicate the amount or other details about the debt.

Individual or organization

Address

 

 

 

 

 

 

 

       h.  the name of every individual or organization that is financially indebted to you in anamount greater than $10,000:

Instructions: Do not indicate amount or other details respecting debt.

Individual or organization

Address

 

 

 

 

 

 

 

       i.   the name of every individual or organization to which you transferred a disclosed assetor with whom you settled a disclosed liability:

Instructions: List only transfers or settlements since you became a member or since yourlast disclosure statement was filed.

Note: A disclosed asset or liability is an asset or liability required to be disclosed whetheror not previously included in a disclosure statement.

Individual or organization

Address

Asset or liability

 

 

 

 

 

 

 

 

 

 

       j.   all payments received by you from a recognized party or an electoral districtassociation:

Instructions: List only payments received since becoming a member or since lastdisclosure statement filed.

Payment source

(recognized party or electoral district assn.)

Amount

Date

 

 

 

 

 

 

 

 

 

 

       k.  any gifts with a value greater than $250.00 received by you

Instructions: Do not include gifts from your spouse, dependent children or members ofyour immediate family or your spouse’s immediate family. List only gifts received sincebecoming a member or since last disclosure statement filed.

Gift

Received from

Value

 

 

 

 

 

 

 

 

 

 

5)   Oath or affirmation

I swear that information contained in this statement is, to the best of my knowledge,information and belief, a full and true disclosure of my interest as of_________________, 20___, as required by the Conflict of Interest Act.

Sworn to at _______________________
in the County of ____________ this ___
day of _________________ 20___, before me

 

 

 

 

 

(Commissioner, judge, barrister,

commissioner of oaths, notary public –

other than a member of the House of

Assembly or the Executive Council)

 

(signature of member)

For Use of Commissioner Only

Filed on ____________________, 20___

 

 

(signature of Commissioner)

 

 

Form B: Disclosure Statement on Behalf of Member’s Spouse and Dependent Children

Province of Nova Scotia

Conflict of Interest Act

 

1)   Statement information

This disclosure statement is filed on behalf of the spouse and dependent children of:_______________________________ (type or print name of member in full), a member of theHouse of Assembly/Executive Council.

 

This statement is an (check one):

[ ]

initial statement

(to be filed within 30 days of becoming a member or within 90 days ofacquiring a spouse)

[ ]

annual statement

(to be filed on or before June 30 each year)

[ ]

amended statement

(to be filed within 90 days of acquisition or disposition of asset or liability)

 

2)   Information about member

       a.   Electoral district you represent: ______________________________________

       b.   List of any appointments held by you under Executive Council Act:

 

 

 

c.Your office address:

 

 

 

(street)

(municipality)

(postal code)

 

d.Your permanent residence civic address:

 

 

 

(street)

(municipality)

(postal code)

 

e.Your telephone numbers

       •    constituency office: _____ - ______ - __________

       •    caucus office: _____ - ______ - __________

       •    ministerial office: _____ - ______ - __________

       •    permanent residence: _____ - ______ - __________

 

f.Name of your spouse:

Note: “spouse” is defined in the Act as “a person who is married to, a domestic partnerof or living in a conjugal relationship with a member and includes a person of the samesex as a member, but does not include a person who is separated and living apart from amember”.

 

       g.   Names of your dependent children:

 

 

 

Note: “dependent child” is defined in the Act as “a child who is under the age ofmajority or, although over the age of majority, unable, by reason of illness, disability orother cause, to withdraw from the charge of the person’s parents or provide himself orherself with reasonable needs”.

 

3)   Exclusions

You are not required to disclose any of the following in this disclosure statement(subsection 11(3) of the Conflict of Interest Act):

 

       •    assets and financial interests having a value of less than $10,000

       •    a debt you owe to your spouse, a dependent child or a member of your immediatefamily

       •    a debt owed to you by your spouse, a dependent child or a member of your immediatefamily

 

4)   Disclosures

For each item, indicate the person to whom the listed item relates (name of spouse ordependent child). For an amended statement, list only changes since last disclosurestatement and indicate whether they are acquisitions or disposals.

Attach a schedule if there is not enough space on [the] form.

 

You must disclose all of the following information (subsection 11(2) of the Conflict ofInterest Act):

 

       a.   the name of every individual or organization that in any manner whatsoeverremunerates or contributes to your spouse or dependent children, including anyreimbursement for expenses made to your spouse or dependent children:

Instructions: Indicate capacity in which remuneration is received and include address ofeach individual or organization named. Do not indicate amount of remuneration orcontributions. Do not list payments included in item j.)

 

Individual ororganization

Civic address

Capacity inwhich received

Member offamily

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

       b.  the issuer or name of any bonds, debentures, holdings in investment funds, mutualfunds, investment trusts or similar securities your spouse or your dependent childrenhave:

Instructions: Do not include:

       •    Canada Savings Bonds or other investments or securities of fixed value issued orguaranteed by any level of government in Canada or an agency of a government inCanada,

       •    registered retirement savings plans that are not self-directed,

       •    open-ended mutual funds,

       •    guaranteed investment certificates or any similar financial instruments,

       •    annuities and life insurance policies

       •    pension rights

Do not indicate the amount or value.

Name/issuer of bond, debenture etc.

Member offamily

 

 

 

 

 

 

 

       c.   the nature and location of any interest your spouse or dependent children have in orwith respect to real property, whether situate within or outside the Province:

Instructions: Do not include any interest in or with respect to real property that is usedby you, your spouse or your dependent children for residential or recreational purposes. Do not list an interest in real property of a corporation of which you are a shareholder.

Location of property

Nature ofinterest

Member offamily

 

 

 

 

 

 

 

 

 

 

       d.  unless excluded in b., the name of every corporation, or subsidiary of a corporation, inwhich your spouse or dependent children hold a beneficial interest, a share warrant orpurchase option:

Instructions: Do not indicate the amount or value.

Name of corporation

Member offamily

 

 

 

 

 

 

 

       e.   the nature of any interest of your spouse or dependent children in property of a kindrequired to be disclosed in b., c. or d., and over which you, your spouse or yourdependent children have a general power of appointment or an expectancy under atrust:

Nature of interest in disclosed property

Member offamily

 

 

 

 

 

 

 

       f.   any trust established for your spouse or dependent children, and the names of thetrustees and the contributors to the trust:

Instructions: Do not include a trust established by you or your spouse for yourdependent children.

Name of trust

Contributors totrust

 Trustees

Address fortrustees

Member offamily

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

       g.   the name of every individual or organization to which your spouse or dependentchildren are financially indebted,

Instructions: Do not include a debt that

       •    is a current and ordinary household and personal living expense of yours or yourspouse or your dependent children

       •    is in respect of an automobile, a boat used for recreational purposes, or recreationalvehicles of yours or your spouse or your dependent children

       •    is money or other property entrusted to or received by you in trust for a person otherthan you or your spouse or your dependent children

       •    is in respect of an interest of yours that is not required to be disclosed in b. or c.

       •    is less than $10,000

Do not indicate the amount or other details about the debt.

Individual or organization

Address

Member offamily

 

 

 

 

 

 

 

 

 

 

       h.  the name of every individual or organization that is financially indebted to your spouseor dependent children in an amount greater than $10,000:

Instructions: Do not indicate amount or other details respecting debt.

Individual or organization

Address

Member offamily

 

 

 

 

 

 

 

 

 

 

       i.   the name of every individual or organization to which your spouse or dependentchildren transferred a disclosed asset or with whom they settled a disclosed liability:

Instructions: List only transfers or settlements since you became a member or since yourlast disclosure statement was filed.

Note: A disclosed asset or liability is an asset or liability required to be disclosed whetheror not previously included in a disclosure statement.

Individual or organization

Address

Asset orliability

Member offamily

 

 

 

 

 

 

 

 

 

 

 

 

 

       j.   all payments received by you from a recognized party or an electoral districtassociation:

Instructions: List only payments received since becoming a member or since lastdisclosure statement filed.

Payment source

(recognized party or electoral district assn.)

Amount

Date

Member offamily

 

 

 

 

 

 

 

 

 

 

 

 

 

       k.  any gifts with a value greater than $250.00 received by your spouse or dependentchildren

Instructions: Do not include gifts from your spouse, dependent children or members ofyour immediate family or your spouse’s immediate family. List only gifts received sincebecoming a member or since last disclosure statement filed.

Gift

Received from

Value

Member offamily

 

 

 

 

 

 

 

 

 

 

 

 

 

5)   Oath or affirmation

I swear that information contained in this statement is, to the best of my knowledge,information and belief, a full and true disclosure of the interests of my spouse anddependent children as of _________________, 20___, as required by the Conflict ofInterest Act.

Sworn to at _______________________
in the County of ____________ this ___
day of _________________ 20___, before me

 

 

 

 

 

(Commissioner, judge, barrister,

commissioner of oaths, notary public –

other than a member of the House of

Assembly or the Executive Council)

 

(signature of member)

For Use of Commissioner Only

Filed on ____________________, 20___

 

 

(signature of Commissioner)